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EDITORIALS: Jean-Claude Carel and Claire Levy-Marchal Renal complications of childhood type 1 diabetes BMJ 2008; 336: 677-678 [Full text]

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Young people are given no chance to have normal blood sugars to reduce renal and other complications of diabetes

Katharine Morrison   (1 April 2008)

Young people are given no chance to have normal blood sugars to reduce renal and other complications of diabetes 1 April 2008
Katharine Morrison, Principal in General Practice Ballochmyle Medical Group Mauchline KA5 6AJ Send response to journal: Re: Young people are given no chance to have normal blood sugars to reduce renal and other complications of diabetes	The solution to the complications of diabetes that children and adolescents face is under their noses. What they put in their mouths and swallow has the most important impact on their blood sugars. Unfortunately youngsters and their parents have been fed wrong information about what macronutrient food composition is best for diabetes. This has been going on for decades and it is time for a change. My 16 year old son has had type one diabetes for four years. His hbaic has varied from 4.8 - 6.2 % over this time and his latest was 5.3%. He uses half unit pens, three different types of insulin, monitors meticulously, uses a carbohydrate restricted diet and carefully matches his basal and meal requirements to his insulin. On this regime he has infrequent and only mild hypoglycaemia. What sort of chance do young people with diabetes have? In order to avoid the complications of diabetes you need to have normal blood sugars. This means pre meal blood sugars of 4.6 mmol/l, a hbaic of 5.5 or below and the avoidance of post meal spikes and hypoglycaemia. This is only acheivable with a restricted carbohydrate diet. The average hbaic of 9.8% corresponds with what I see in my young patients who attend local diabetic clinics. I have yet to see a parent of a young diabetic who did not do everything in their power to help their child with this disease. This means spending time making high carbohydrate/low fat meals which are supposed to be "heart healthy". Until the dieticians in the NHS get their act together young diabetics face a shorter and much nastier life than they deserve. It is entirely possible to have normal blood sugars and hardly any hypoglycaemia without the use of expensive insulin pumps and monitoring paraphenalia. It is not possible to avoid the complications if you turn up regularly at diabetic clinics and do what you are told. Nielsen J V, Jönsson E, Ivarsson A. A low carbohydrate diet in type 1 diabetes: clinical experience - a brief report. Ups J Med Sci 2005;110:267 -273. Facchini F S, Saylor K L. A low iron available, polyphenol enriched carbohydrate restricted diet to slow progression of diabetic nephropathy. Diabetes 2003;52:1204-1209 Bernstein R K. Virtually continuous euglycemia for 5 yr in a labile juvenile-onset diabetic patient under noninvasive closed-loop control. Diabetes Care 1980;3:140-143 Bantle J P, Laine D C et al. Postprandial glucose and insulin responses to meals containing different carbohydrates in normal and diabetic subjects. N Engl J Med 1983;309:7-12 American Diabetes Association (ADA). Nutrition recommendations and interventions for diabetes-2006. A position statement of the American Diabetes Association. Diabetes Care 2006;29:2140-2157 Competing interests: None declared