QUESTIONS AND ANSWERS FORUM
Q) Within the context of the medical recommendation that kids with type 1 diabetes be on the Priority List for the flu vaccine, there has been a discussion of whether their immune system is considered "compromised" versus "dysfunctional." Is their immune system "compromised" or "dysfunctional?" If our kids' immune systems were fine, with the exception of the attack on the beta cells, it seems there would be no need for special recognition with regard to things like the flu vaccine.
A) Patients with diabetes who have good blood sugar control are at no increased risk of infection. At higher blood sugars there is impairment of the immune system predominantly cell mediated immunity, required to ward off most bacterial infections and wound healing is also impaired. Flu vaccines are recommended for people with diabetes because of the deleterious effects of illness on blood sugar control, and this may lead to other complications, not because they are more prone to infection.
Q) My 11-year-old son has type 1 diabetes and uses an insulin pump. He eats a lot of sandwiches and toast. What is the best type of bread to give him?
A) In theory the glycaemic index (GI) of the carbohydrate may affect blood sugar levels. Therefore the lower the G.I of the bread the lower and slower the rise in blood sugar after consumption. Therefore seed bread-rye bread are lower GI than brown or whole-wheat bread which are lower than white bread.
Q) I have been told that, in England, they can cure type 1 diabetes by taking enzymes from the parents and injecting it in the child's pancreas. Is this true?
A) No, they are replacing islet cells predominantly beta cells, not enzymes.
Q) If yes, whom do I have to contact to get full information?
A) These islet cell transplants are not being performed on children as they require life-long immunosuppressive therapy to prevent rejection of the new cells. This suppressive therapy is not benign and may cause cancers down the line.
Q) And, if no, what is the latest news on any progress for treatment of type 1 diabetes?
A) Stem cell research holds the most promise for a cure. Stem cells can be harvested from ones own body from the spleen or bone marrow and chemically engineered too become new insulin producing cells. These cells because they are from "self" do not require immuno-suppressive therapy, however they may still be attacked by the immune system that destroyed the original beta cells. Therefore new medications need to be found that can safely prevent these new cells from attack.
Q) I also would like to know what is the most suitable type of pump available for a seven-year-old child with diabetes?
A) There are 2 pump companies in South Africa, Minimed Medtronic and Roche both have good pumps.
Q) Does anyone know of doctors that are doing current studies on implant able pumps? Are they happening or soon to be happening anywhere else?
A)Implantable pumps are a reality trials are ongoing in Europe and America. No one in South Africa is doing implantable pumps at present. The concept is good, the results are good, logistics in terms of pump and recipient size is still a concern.
Questions 2006
Q) Where can I get a list of "free
foods" appropriate for a teenaged boy? He is counting carbohydrates.
A)Try the South African Carbohydrate counting
book. I think it is available at CNA and Woolworths.
Q) Our four-year-old grandson was just diagnosed with type 1 diabetes. He has an identical twin brother. Do you think he should also be tested?
A) No, there are tests that can be done to predict whether he may develop diabetes, but these are not 100% predictive. The chances of developing diabetes are high, approximately 50% over his lifetime. Unfortunately we do not have any current prevention methods, if we did I would recommend screening.
Q) My 10-year-old son was diagnosed with type 1 diabetes when he was six.
We have learned everything we could possibly want to know about diabetes.
Don't get me wrong; I do not think I know everything about diabetes. There
are always new things to learn. I want to know why we have to see the
doctor every three months? We do have the A1c test done every three months,
but I have been scheduling his visits about four to five months apart.
His last two A1c tests were 6.1 and 6.4. I feel we are doing a good job
with helping our son keep his blood sugars at a good level. When we go
to an appointment, the doctor asks us his levels on the pump, how much
insulin he is on and so forth. We asked him when would our son need to
be tested of certain problems and he said most type one diabetics don't
seem to have problems until they have had if for five years. He would
not recommend any testing until he's had diabetes for five years. Why
do we have to go every three months? It does not seem like we get much
accomplished at these visits.
A) Regular visits help your doctor and you. Diabetes is never as predictable
and as easy as one would want it to be. As you are well aware many curve
balls can get thrown your way. It appears that you have achieved a good
balance and are achieving good targets even if the HbA1c is a little on
the low side. Diabetes related complications are closely related to HbA1c
and it is true that we do not expect complications prior to puberty in
well-controlled children.
Q) Is there a way to calculate the number
of carbohydrates per serving in a recipe? I understand how to count carbohydrates
and read nutrition labels, but how do I count carbohydrates when cooking
from scratch using milk, sugar, flour, etc.?
A) This information can be obtained from the carbohydrate counting book. - Book to be advised shortly.
Q) My five-year-old daughter has had type 1 for one and a half years. About a week ago, we lowered her insulin dosages due to lows. From everything that I have read, I just assumed that her insulin needs would becoming more, not less. She just started kindergarten this year and her activity level has decreased, which I thought would mean an increase in insulin, not a decrease.
A) Their will always be periods of fluctuating insulin sensitivity and
also production at the tail end of the honeymoon period. Unfortunately
we cannot always predict the trend and that is why monitoring, pattern
recognition and adjustments are vital. Your assumptions are correct, but
the disease does not always read the test book.
Q) What is your opinion of the OmniPod for use by a five-year-old boy
diagnosed almost a year ago? He is now on injections, with his latest
A1c 6.2. I would be interested in getting one before he goes to school.
Can a school nurse be trained to program the device? Is it safe enough
for use in little kids? And is it available in South Africa and how much
are they?
A) I do not think that the Omni Pod is available in South Africa.
Q) When is the best time to put a child on a pump? My daughter is still honeymooning. Should I wait until she is done honeymooning or can I start her now?
A) There is no perfect time. In some European
countries newly diagnosed children are offered the pump from day 1. I
think that a thorough understanding of diabetes, diet and management principles
is a pre-requisite to pump therapy. If you feel comfortable with these
then a pump is certainly an option.
Q) My son gets injected twice a day and still cries when we have to give it to him this does not happen every time but does happen at least 6 out of 10 times – is it still painful for him?
A) There is probably some needle phobia,
some pain and also some acting out. Nobody wants diabetes and certainly
nobody likes injections. Refusal to have injections may just be a way
of demonstrating anger, and denial which are both normal responses to
the diagnosis and part of the stages of grieving.