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From Brooklin, Ontario, Canada:

What are the likely long-term effects on a child diagnosed with type l at the age of two? There don't seem to be any studies done. Even though my granddaughter is now on an insulin pump in hopes of regulating her blood sugar levels better than with the insulin injections, what does she have to look forward to as she ages? How well does the body cope and what are the major concerns for juvenile diabetes taking into account the many more years than an adult being diagnosed?

In addition, there seems to be a lack of assistance on the part of school boards in Ontario to assist through means of nurses or other trained staff to handle diabetics. This is very serious and is left mainly to the families to do all monitoring at the school level. If my six year old granddaughter were to slip into a diabetic coma in school, what brain injuries could result? I have many questions and few real or reassuring answers.


Your questions are well understood. There are plenty of studies and much evidence that describe the outlook and risk of complications of poorly controlled diabetes. It is the length of time as to how poorly controlled the patient is, not the age of onset. So, someone could be diagnosed at the age of two and be in great control for 70 years and thus have a smaller risk of complications compared to someone age 65 years at diagnosis but poor control for five years.

Indeed, it appears that five years of poor control increases the risks of eye, kidney, and nerve complications and probably associated heart issues associated with elevated lipid levels. Unfortunately, it may be five years "cumulative" and not so much as five years in a the younger the child, the potential additive effects over time.

But, note I am emphasizing "POOR control." In the early 1990s a landmark study, the Diabetes Control and Complications Trial ("the DCCT") really helped define those patients at risk of complications and at risk of progression of already-present complications. The risks are very much associated with the level of a glucose monitoring test called the "hemoglobin A-1-c" test - which is commonly abbreviated as the HbA1c or A1c. Your grandchild will likely get this done now every two to four months. Good control of diabetes diminishes the risk of complications and the progression of pre-existing complications. One does not necessarily require "perfect" control.

Your ongoing support of her efforts to maintain a healthy attitude about checking glucose levels, dosing insulin appropriately for the food she takes in (given that she is on an intensive insulin regimen using an insulin pump), and keeping active cannot be emphasized enough.

As for the support and help from the school, I am sorry that I do not have information as to requirements of the Canadian school system. In the U.S., schools that receive federal monies are required to provide certain degrees of assistance and latitude for the child with diabetes. Your grandchild's pediatrician, or perhaps better yet, her pediatric endocrinologist/diabetologist is in a far better position to address these issues with you and her family. I have 17 listed physicians from Ontario in my directory of the North American pediatric endocrine society. I do not know who is seeing patients, but the listed cities include Hamilton, London, Manotick, Ottawa, Richmond Hill, Scarborough, and several in Toronto.


[Editor's comment: You may also want to contact the Canadian Diabetes Association for information on school issues. BH]

Original posting 11 Jan 2005
Posted to Other and School and Daycare


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