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RE: [IPk] Pituitary and BG



Hi Jos

Has Emily been tested for Addison's disease?  I dont know enough about what
tests are required for this condition.

I have been told that because Sasha has diabetes and coeliac that she has
polyglandular disorder.  I try not to think too much about the other possible
conditions that she may or may not ever develop but am aware of some of the
other conditions such as Addison's disease.


http://www.childrenwithdiabetes.com/dictionary/a.htm#AIPGS
"Autoimmune polyglandular syndrome
A group of autoimmune disorders that involve endocrine glands and which result
in failure of the glands to produce their hormones. (Also called autoimmune
endocrine failure syndrome, autoimmune polyendocrine syndrome, and
immunoendocrinopathy syndrome.)


Type I
A disorder that includes hypoparathyroidism, candidiasis and Addison's disease
(adrenal gland failure). 15% have autoimmune Type 1 Diabetes. It has recently
been shown that there is a mutation in the AIRE (AutoImmune REgulator) gene on
chromosome 21.

Type II
 A disorder in which two or more autoimmune conditions are found. 50% show Type
1
autoimmune diabetes and another associated condition, which may include
Addison's disease, the celiac syndrome, vitiligo, pernicious anemia, myasthenia
gravis, Graves' disease, and others".


Some info here:
Addison's disease in type 1 diabetes presenting with recurrent hypoglycaemia
http://pmj.bmjjournals.com/cgi/content/abstract/76/894/230

http://pmj.bmjjournals.com/cgi/content/full/76/898/523b


Full free text here: copy and paste if URL wraps


http://pmj.bmjjournals.com/cgi/reprint/76/894/230?ijkey=b3960cd7dd3544f6d35361ef
57c41fcf08c45f25

Some of the text I have copied here:

" In patients with type 1 diabetes show develop unexplained recurrent
hypoglycaemia, the development of an associated endocrinopathy , such as
Addison's disease, should be considered.

An unexplained reduction of total insulin requirements of more than 15 -20% (in
response to recording frequent low blood glucose values should arouse suspicion
of adrenocortical insufficiency.  This may precede clinical features.

In children or teenagers with type 1 diabetes, a clue to underlying Addison's
disease is a decline in normal growth velocity."

I couldn't copy and paste so have typed this from the site, hope there aren't
too many spelling mistakes.

What have the diabetes team said about your thoughts/worries?

I hope it all turns out to be nothing much in the end.


Sasha's basal rate is still around 45-50% of the total daily insulin is now
around 46 - 52 units a day!! She weighs about 39 kilos and is 151 cm tall. She
 is very slim still and now taller and more developed than her twin sister
Beckie
who was always the bigger, taller twin from birth, (until now that is)!

Sasha's diabetes is still quite hard to control now as she is having monthly
cycles. but no periods yet!  Two weeks of lower levels then two weeks when she
needs between 130- 150% basal rates.  Cant do anything other than respond when
and if things happen.  Cant even change the basal rates because we never know
when we will need to increase or drop them.  The upside is that we can still
keep the HbA1c below 7% fairly easily with management.



Jackie mum of Sasha

PS

> -----Original Message-----
> From: email @ redacted [mailto:email @ redacted]On
> Behalf Of J
> Sent: 11 June 2006 15:03
> To: email @ redacted
> Subject: [IPk] Pituitary and BG
>
>
>
> Does anyone know how hypopituitary problems might affect BGs and
> basal rates? Emily has secondary hypothyroidism (TSH 1.64 normal
> range 0.35-3.5, T4 7 normal range 8-21, low thyroxine dose, 25mg).
> She has some symptoms of cortisol deficiency but they are pretty
> general and could be symptoms of something else. I'm wondering if her
> change in basal rates suggest anything more definite, either for or
> against cortisol involvement.
>
> A year and a half ago Emily's basal insulin made up 34% of total
> daily insulin (55 units). Now it's 21% of the same total. The basal
> rate pattern seems similar between 2am and 2pm (steady until an
> increase from 6am, peaking at 8am, dropping back down by 11am). The
> rates between 2am and 2pm used to be between 0.5 and 0.8 with a small
> peak at tea time and rising again from 10pm. Her basal rates now are
> 0.1 from 2pm until 12 am then rises each hour to 0.4, 0.6 and 0.8 at
> 2am. Despite the low basal rate during the evening she is having
> hypos between 10/11pm and 1am with no links to too much insulin,
> exercise, etc. For eg. last night her last insulin was 1.5 units at
> 7pm. Her BG at 10.14pm was 9.1 and she was 3.5 by 12am. This was
> after a lazy day. 50% of Emily's hypos happen during this late
> evening/early morning time now compared to none a year and a half ago
> despite the much lower basal rates during the afternoon and evening.
>
> Does anyone recognise thy type of problem? Emily is just 14 and
> currently takes about 1unit/kg/day.
>
> Thanks,
> Jos
> .

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