Re: Ashley's Story

Charles Antony wrote in message ...
>Ashley's Story
>
>
>
>My name is Charles, and I am from Toronto, Canada. I am sending this note
>out to see if you could share your thoughts on Ashley, my niece. Ashley is
>your typical 9-year old--vibrant, bright and playful. Ashley is also
>diagnosed with Type II diabetes. Ashley's diagnosis simply devastated us.
>However, we were pleasantly surprised to see her conditions bounce back to
>normal since the initial diagnosis. We subsequently stopped the insulin
>injections and Ashley has been fine ever since, for about two months now.
>However, the endocrinologist at Toronto Hospital for Sick Children (THSC)
>thinks Ashley is going through her "honeymoon" period.
>
>
>
>According to the endocrinologist, Ashley is feeling well now because she is
>in her honeymoon period where the leftover beta cells are working extra
hard
>to produce the necessary insulin and Ashley can relapse in the next 6
months
>when her remaining beta cells eventually get destroyed. He advised us not
to
>get the hopes up and prepare to accept reality. Having researched on the
>topic, it became clear Ashley is most likely type II diabetic and she is in
>her honeymoon period. However, there are number of things about Ashley that
>do not fit well with a typical type II diabetic child. This prompted me to
>post this article and solicit more opinions, advice and comments to
>demystify Ashley's conditions.
>
>
>
>
>
>Chronology of Events
>
>
>
>Following are progressive events on Sarah's diagnosis, treatment and
>progress:
>
>
>
>      Oct 2005
>     On a routine blood test slightly elevated blood sugar level (HbA1c 
>0.064) was observed. No treatment was recommended and the family doctor
told
>us not to worry. However, my sister had been checking Ashley's blood sugar
>ever since on a weekly basis, and it was very stable and normal.
>
>      Feb 24, 2006
>     Ashley was taken to the family doctor with an intense cough and she
had
>difficulty breathing (she is not asthmatic).Her blood sugar and insulin was
>fairly normal with HbA1c = 0.062 and fasting sugar = 4.6 (glucometer
>reading). Suspecting respiratory infection, the doctor prescribed an
>antibiotic (Cefzil) and to help Ashley's breathing, he also prescribed an
>anti-inflammatory (Prednisolone). Following are the actual dosages of each:
>
>        1.. Cefzil 5m(x3), twice a day for 5days (antibiotic)
>        2.. Prednisolone 10ml(x2), twice a day
>
>      Mar 03, 2006
>
>      (Following Friday)
>     Ashley's sugar level shot up to dangerous levels (18-20 in the
>glucometer) and Ashley looked very weak. She was rushed to THSC where she
>was eventually diagnosed to be Type II diabetic. Some nurse attended Ashley
>hypothesized that the diabetes could have been induced/unmasked by the
>strong dosage of Prednisolone that she was on. When we brought it up, the
>endocrinologist discounted the notion of Prednisolone link. A diabetic
>treatment was initiated and her sugar level began to subside.
>
>      Mar 08, 2006
>     Ashley was put on insulin dosage. Her dosage was:
>
>        a.. Rapid (M-3 + After 2), Normal (M-7 + After 2)
>        b.. 14 units (10 units in the morning, 4 units in the evening)
>      We also put Ashley on a diet where meals were given in regular
>intervals and the sugar intake was measured and controlled. We were
>instructed to monitor Ashley's fasting sugar level and adjust the insulin
>dosage accordingly. Ashley was responding really well and we started
>reducing her insulin dosage after 3 days, according to the instructions
>given by the doctor. On March 29th, we only gave Ashley N2 insulin.
>
>      Apr 18, 2006
>     Ashley was completely weaned off insulin.
>
>
>
>
>Observations
>
>
>
>Following are some of the key observations we were able to make that form
>the basis for my questions:
>
>·         It is said that exercise does not have any impact on type II
>diabetic patients. However, exercise (walking, swimming, and yoga) reduced
>Ashley's sugar level noticeably.
>
>·         Ashley's beta cell test (anti islet cell test) performed after
the
>diagnosis was negative indicating Ashley was not loosing any beta cells.
The
>endocrinologist theorized that Ashley was not loosing any beta cells when
>the test was actually administered. Further, he concluded that there is 95%
>chance that Ashley was Type II diabetic, meaning there is a 5% chance
Ashley
>is not diabetic.
>
>·    >
>·         Ashley's siblings are perfectly healthy.
>
>·         Ashley did not exhibit any type II diabetic symptoms including:
>ketone in blood, excessive thirst, and urinate frequently.
>
>
>
>
>
>My Questions
>
>
>
>Naturally, we have a number of questions regarding Ashley's health. The
>staff at THSC has been more than helpful and courteous and I don't intend
>disregard or disrespect their assessment of Ashley's conditions. I just
have
>some unanswered questions and was hoping to get some answers from a wider
>forum, while conveying Ashley's story. My questions are:
>
>·         How can Ashley go from being perfectly healthy (on Feb 24th) and
>Type II diabetic in a week (Mar 03rd)? Can the sugar level increase that
>rapidly over such a short period of time? Wouldn't you expect the sugar
>level to gradually rise if you are diabetic?
>
>·         Is it possible that Ashley's diabetes was triggered by
>Prednisolone (please see my research in Appendix A)? If so, was Ashley
given
>a heavier dose that she needed?
>
>·         Since Ashley did not show most of the symptoms of a type II
>diabetic patient, except for a temporary short sprout in blood sugar level,
>is it possible that she was rashly misdiagnosed? Are there any more tests
>that we can perform to confirm her diagnosis with a higher degree of
>accuracy?
>
>·         If there is 5% (according to endocrinologist) chance that Ashley
>is not diabetic, what could explain the whole episode?
>
>·         Assuming Ashley is in her honeymoon period, is there a way to
>extend it? Are her conditions reversible?
>
>·         Should Ashley's siblings be worried? Are there any precautions
>that they can take?
>
>·         How did exercise help with Ashley's blood sugar level when she is
>diagnosed with type II diabetes?
>
>·         Is there an alternative treatment method to reduce/control Type
II
>diabetes?
>
>·         Does exercise help with Type II diabetes? If so, what type of
>exercise?
>
>·         Does diet help with Type II diabetes? If so, what type of diet?
>
>·         Is there an alternative method to administer insulin than
>injections?
>
>·         Are there any emerging/promising (clinical) treatments for Type
II
>diabetes?
>
>·         Can the beta cells be harvested from Ashley's twin sister and
>transplanted to Ashley?
>
>
>
>
>
>Thanks for your time and kind words. Take care.
>
>
>
>Truly
>
>Charles
. . . .(snip). . .


You have made a variety of medical statements in your post which are
inconsistent with Type 1 and Type 2 diabetes as I know them.    I'm not
trying to be sarcastic or even ironic when replying at a time in which
Ashley's condition must be devastating to you.   However,  I am afraid that
your research has not been deep enough and/or you have been too anxious and
too intent in looking for "some way out".

Some remarks from my side   (Research Engineer with diabetes,  not a medical
person)

1.  Ashley is exhibiting symptoms quite typical of a Type 1  (Type I)
diabetic.

Although thirst,  excessive urination and the like are symptoms of
developing diabetes,   the acceleration effect of prednisone could easily
have masked them.

FWIW,  I did not experience any of the classical physical symptoms other
than blurred vision and, of course, high blood sugars.

2.  A juvenile Type 1 diabetic can go from "no physical symptoms" and normal
blood sugar to sky-high sugars and DKA coma in a week.

As a parent of a suspected Type 1 diabetic child,  you must be aware of the
symptoms of DKA.   Please read and try to understand these medical papers:

http://www.ispad.org/clin-2.htm

http://www.emedicine.com/EMERG/topic373.htm

Please memorize the symptoms  and/or post them in view somewhere.

The first symptom of approaching DKA is high blood sugar.   Since DKA can
cause rapid-onset death,  please,  please, please continue to monitor her
blood sugar.

Pay special attention to her blood sugar at 2 hours after a meal.   A
non-diabetic would be expected to be at 5 mmol/L  or lower at that time.

It is not clear to me why you "weaned" her from insulin injections.   The
first treatment for DKA is insulin injection.  Daily insulin injections are
a preventative against DKA.

3.  Type 1 diabetes is genetically induced and mildly hereditary.   It is an
autoimmune disease triggered by "something or other".

"Something or other" can be a variety of stress factors,  ranging from a
virus to a food allergy to personal stress.     A Type 1 diabetic can have
no known diabetic relatives of any Type   (like me, for instance),   or be
part of a family in which every child and grandchild of a T1 is also T1.

In contrast,  Type 2   (Type II) diabetes is almost always strongly
hereditary.

Sorry,  but your statement:

". . .     No one from Ashley's family (from both of her parents' sides) is
diabetic. Ashley's illness cannot be hereditary. . . ."

is totally in error.

There is no known,  reliable preventative therapy for approaching Type 1
diabetes.   There is no "restorative" therapy (transplant from sibling)
There is no way to protect other family members.

Type 1 is an autoimmune disease.  Researchers are experimenting with immune
suppressive drug therapies but there is nothing available outside of the
clinical trials.

4.  Prednisone unmasks developing diabetes of any type.    It "orders" our
livers to produce extra glucose.    If our beta cells have been damaged by
some form of diabetes,   they cannot handle the extra glucose and our blood
sugars rise.

There is a theory that the extra work load produced by the release of extra
sugars can accelerate an existing diabetic beta cell destruction mechanism.
Therefore,  in theory, prednisone can accelerate the arrival of developing
diabetes.   That is not the same as "induce" or "cause" diabetes.

4.  An HbA1c of 0.064 is not "slightly elevated"   It  is high, and
consistent with approaching full-blown diabetes.

My HbA1c has not been that high since I switched from old-fashioned
insulins to modern insulins several years ago.

(Think about the above statement if your doctor prescribes "old-fashioned"
insulins when and if the time comes.   The modern insulins:    Humalog,
Novolog,  Apidra;   Lantus and Levemir  are much easier to use.    Easier to
use means better control which means lower chance of diabetic
complications.)

The best study of HbA1c  I have seen is the U.S. Third National Health and
Nutrition Examination Survey (NHANES) which reports an average of 5.0% for
non-diabetics.    NHANES is a large study with enough subjects to produce an
expectation of accuracy.

(Note that  most of us use the percentage version of HbA1c,  i.e.  6.4%)

5.  Exercise helps control blood sugar in any and all diabetics.

When I was in my honeymoon stage,   the only way I had available to knock
down a high blood sugar was riding a stationary bike.   A 4-minute mile
would knock my sugar down by an average of 1.1 mmol/L.

6.  Injection,  either by syringe,  pen or insulin pump is the most reliable
and accurate method of delivering insulin.     There is an experimental
"inhaled" insulin being tested.     I cannot imagine using it on either a
child,  or any Type 1 diabetic.

Please investigate the costs and capabilities of an insulin pump.   It is
the most powerful and reliable insulin therapy available right now.

Most insulin therapies for children are "second-best" therapies,  used
because the child has limited understanding and is unavailable to the
parents during much of the school day.     Pump therapy is capable of
sidestepping these limitations.

7.  "is it possible that she was rashly misdiagnosed?".       I cannot
believe that  (except for the fact that Type II is being mentioned so often
when applied to a child with clear Type 1 symptoms).    Non-diabetics do not
experience blood sugars much above 8 for any reason at any time.    Two
readings of 11 or more are considered sufficient for the diagnosis by most
docs.

I commend whoever put Ashley into Emergency care when she spiked to 18
mmol/L.    She was in serious danger at the time.

The gentleman who put together this web site

http://www.rajeun.net/gtt.html#Diabetes and Hypoglycemia

http://tinyurl.com/c5xqo

has harvested responsible medical citations of blood glucose readings for
non-diabetic and diabetics when stressed by glucose ingestion.

Note that he uses the U.S. notation of mg/dL.    ( 18 mg/dL  = 1.0 mmol/L.)
Ashley's 18-20 mmol/L correspond to U.S. blood sugars of 324 - 360 mg/dL.

Mr. Toussier is not a doctor but, as I stated,  he quotes responsible
medical sources.\

Good luck and please,  please test her blood sugars frequently.   DKA is
dangerous.

Regards
Old Al
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Antworten

Charles Antony (29.05.2006 09:01)
old al (29.05.2006 13:45)
OL (28.06.2006 14:29)