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Re: [IPk] urgent info request re: children

To everyone other than Elizabeth: N.B. Exceedingly long post with several
anecdotes thrown in follows; you've been warned...!


I'll do my best to answer your questions in order:

1) YES!!!  Excessive thirst and frequent urination (even bed-wetting among
children well past potty training) are the most classic symptoms, along with
excessive hunger and food consumption BUT rapid weight-loss.  Dry skin (which
could be what's been dxed as excema; that was my situation) and lethargy are
also de rigeur.

2a) Steriod-induced diabetes...interesting, but I'm not so sure.  Remember
that only 5-6% of all cases of t1 are called "hereditary" and that t1 is an
auto-immune disorder.  Very little to be done when the white blood cells have
got going and destroyed at least 80% of one's islet cells (80% depletion is
the threshold for most people to show unmistakeable symptoms).  Current
thinking among many is that some people are born with a higher susceptibility
to T1 than others and a rather intense virus (measles, mumps, chicken pox,
even a bad bout of flu) sets the immune system to full tilt and causes the
damage.  I had chicken pox twice as a child (a pretty mild case at 4 and a
"good" one at 6).  I started having hypoglycemic symptoms at 7 and was
diagnosed with t1 at 12.  It can take a few years for the islet cells to be
depleted enough for the symptoms of t1 to be truly noticable, but when it
rains it pours and it finally looks like a good idea to get someone checked
for t1.

2b) If the diabetes IS steroid-induced, everything should go back to normal
pretty soon after the offending medication is withdrawn, I'd hope.  I once met
a leukemia patient whose insulin production had been totally suppressed by her
chemotherapy.  It wasn't until she was in remission and she blacked out after
taking her normal insulin dose that anyone suspected the diabetes was purely
situational.  (True story!!)

3) I don't really know, but if it's really diabetes the child won't be
producing great amounts of insulin for much longer anyway.  I never had a
"honeymoon period" (that's what it's called in the US and I really don't know
if it's the same in the UK, sorry!); I was on at least 25 u./day from the word
"go."  However, I've met recently diagnosed children who needed just 8 u./day
for months before their requirements skyrocketed.  Would that we could know
for sure just what the immune system does at night...!

4a) A straight-up fasting blood glucose test will tell you what you need to
know.  But do not despair if it's awful: children's systems are _very_
resilient in the face of diabetes.  When I was 12, I had a fasting bg of 37;
when admitted to hospital (immediately upon the return of the test results) my
bg was 46.  My body's "sugar thermostat" (so to speak) had readjusted itself
so that I felt like I had a hypo at 22 my first day on insulin.  No lie.  At
the point of diagnosis (and at any time in the future), a simple urine test
for ketones will indicate if the child has DKA (diabetic ketoacidosis, the
thing we all fear happening if we can't get a high bg down).  As for other
tests, I would think a HbA1c would be useful, so y'all could see how bad
things have been recently and have a starting point from which the only
direction to go is "better."  Keeping morale up can be hard!

4b) As for future tests/things that should be performed regularly: HbA1c,
cholesterol, trigycerides, and blood pressure every 3-4 months; complete eye
exam every year; test for protein in urine every year after 7 years of
diabetes; foot exams if any sensation is lacking or the child seems not to
heal well from blisters, splinters, etc.; and GOOD dental care = VERY
important.  I have mild periodontal disease at age 20 because the two dentists
I saw (1 in Virginia and 1 in Texas) in 2000 and early 2001 did not check me
for it.  I was in (of all places) southern Mississippi when it was caught.
Oh--and a FLU SHOT.  EVERY YEAR.  The only thing worse than getting flu is
being diabetic and getting flu.  In the US it's routine for flu-stricken
diabetics to be admitted to hospital immediately because it's so hard to
control bgs when one can't keep anything down and one's system is fighting the
virus.  On a more day-to-day basis, it's a good idea to test for ketones
whenever a bg has been or could have been above 13 for several hours.  Some
people produce ketones much sooner than others.  I have had small amounts of
ketones a few times in almost 8 years of diabetes, but one of my friends shows
ketones whenever she's got a cold or any other general student-type illness.

4) Best books: check the American Diabetes Association's website.  It's much
better developed than Diabetes UK's site (sorry, it really is!).  From the
"Type 1 Diabetes" page you can click a link to a section called "Parents and
Kids."  You can shop for books in the online store.  Publications endorsed by
the ADA are most often very good.  I am sure that with titles and names of
authors you could order most things through amazon.co.uk and save on the
shipping.  Please contact me off-list if you want to arrange for me to receive
any books you can't get in the UK while I'm at home in Houston (24 Dec. to 10
Jan.);  I'd be happy to bring them back and post them to you.

6-7a) Here are some websites with promising links:
I am sorry (once more) for the heavily American bias.  Fact is, I've not found
very many comprehensive and informative diabetes websites based in the UK.
I've not looked as hard as I might have either, but, to make it up to you,
here's a link to a glucose units converter:

7b-8) If it is diabetes, think about getting counseling.  Really.  The child
in question may be frustrated, angry, rebellious, and discouraged pretty
regularly until she's fully accepted it and able to take full responsibility
for self-management.  While you are trying to be both "Mom" and "caregiver,"
your personal resources will be severely taxed.  When she asks why she has
diabetes and the other kids don't; why she has to test her blood sugar and no
one else does; or why a classmate's mother is scared to have her over for an
afternoon to play, you will have to say something.  My parents were terrific
with me, but I was older and "mature for my age;" it was helpful for my mom
and me to cry together a week after my diagnosis, for example, but that might
not be good for the child you love.  So much depends on individual
personalities that there's no one right way to handle the
emotional/psychological dimensions of t1.  The important thing, I think, is to
acknowledge and _deal with_ those dimensions.  Denial is real and it is bad.
I heard recently of a 20-year old Christ Church undergraduate who got so drunk
she forgot to take her insulin once last year.  A girl who lived with her
then, who is now in my graduate seminar, had to call an ambulance for her when
she found her in a heap on the floor, unresponsive, in a pool of vomit.  Being
clever didn't make the diabetic student responsible for herself.  From what my
acquaintance told me, the girl in question was rather ashamed of having
diabetes and thought the best way to handle it was to pay as little attention
to it as possible--to try to forget she had it.  She may be reminded of her
diabetes every day for the rest of her life if she loses her sight, sensation,
and kidney function because of it.  Still, it's entirely  possible to be too
strict.  I've met children with diabetes who at age 12 could not recall the
taste of chocolate.  Unless a bona fide chocolate allergy is diagnosed, I
think that's punishment and a recipe for disaster.  When a child goes to
university or gets a job or is out of the house unsupervised for a few hours,
bingeing is a distinct possibility. Moderation, moderation, moderation, I say
:> .

And goodnight.  I say that too (arrrghh...1:55 a.m...this is what I get for
checking my e-mail at midnight after an evening in London!).

All the best,
please let me know if I can be of any further use,

IDDM 7+years; Minimed pumper 5+ years; long-winded 20 years+

----- Original Message -----
From: Elizabeth/ Sonya
Sent: Tuesday, December 11, 2001 1:03 PM
To: email @ redacted
Subject: [IPk] urgent info request re: children

Hi all -

My partner's five year old cousin has just been taken to hospital with
suspected diabetes. I have a few questions about things beyond my current

1) Are there illnesses other than diabetes that young children get that
include symptoms such as intense thirst, etc.?

2) This five year old child is on daily adult doses of steroid inhalers,
plus steroid creams in order to control asthma and eczema. She has been on
these dosages for some time: at least a year. I am, therefore, thinking
about steroid-induced diabetes. Questions:

-if her diabetes is steroid induced, will her pancreas still be producing
-if her diabetes is steroid induced, will reducing or eliminating her
steroids (if at all possible) improve her blood sugars
-what should the doctors be looking for in order to determine whether her
diabetes is steroid induced

3) Because of the above, I am thinking about her current level of beta cell
function. What tests should her medical team perform in order to determine
whether her beta cells are still producing insulin (other than the c-peptide
test, which I know about)?

4) What tests should be routinely performed in a case of suspected diabetes
in a child?

5) Can you provide me with a list of the best books about children and
diabetes? I am looking in particular for books that explain good management:
carb counting, matching insulin doses, different insulin regimes, etc.?

6) Can anyone suggest a resource that details the pros and cons of different
insulin regimes with regard to children?

7) If there's anything I've forgot to ask, please let me know!

If you are replying to my mail, could you copy your reply to
email @ redacted? I receive the digest, but I would like to receive
your mail as soon as you respond.


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