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Thursday, December 5, 2013
Cystic fibrosis and diabetes
I have a niece 15 years old with cystic fibrosis and diabetes. I have had difficulty find information about to better educate myself to her needs regarding diet and complications. She is not very compliant with her insulin and her blood glucose monitoring
This really depends on whether or not your niece has type I diabetes or CF related diabetes (CFRDM)-she could have either, as 15 years old is a typical age for type I, and a little earlier than most CF related diabetes.
Both diabetes types are the result of an inability of the pancreas to make enough insulin. In CF, it is from scarring of the pancreas, and in type I diabetes (DM) it is because the body attacks the insulin producing cells of the pancreas, eventually killing them all. The main difference is that in CFRDM there is still some ability to produce insulin, so, in general, the sugar is often a little easier to control, and people shouldn't develop ketoacidosis. In type I DM there is no residual insulin production, so sugars are very variable, and people can develop ketoacidosis.
Most patients with CFRDM, and all patients with Type I DM, will require insulin in the form of injections. Unfortunately, the complications of DM are about the same for those with either type of DM, with the exception of the above mentioned ketoacidosis. Those include the possibility of eye, kidney, and nerve/blood vessel injury, all of which occur sooner and with a greater frequency if sugars are well controlled.
Therapy, from a dietary standpoint, differs a little between the two types. If your niece has purely CF related diabetes, then the only real dietary change we recommend is elimination of sugary drinks:
- excessive juice
- sports drinks
and a decrease in:
- dessert type foods.
This is because weight and nutrition are already problems for those with CF, and we don't want to advocate any changes that may make maintenance of weight more difficult than it already is.
Changes if she has Type I diabetes may be a little more drastic, but I would hope that her endocrinologist would keep in mind your niece's need to maintain good body weight, as that is very important for lung health. No matter what, the principles of keeping track of carbs in the diet, and taking enough insulin to "cover" those is the same in both types.
There are no magic solutions for convincing anyone, adult or teenager, to take the insulin, count carbs, or keep track of sugars. This will be a process that will involve education of your niece, work from the parents, and a lot of encouragement from the diabetes team. It's not inappropriate to make privileges dependent on taking care of oneself. People with uncontrolled DM should not drive, and certainly teens shouldn't be out and about if they are having frequent low sugars, or if their activities are causing them to engage in behaviors that significantly worsen their diabetic control.
As long as your niece's endocrinologist is keeping in mind your niece's need for good body weight (BMI 50% of normal for age and sex), then therapy for her diabetes will be much like any other 15 year old's, and they should be well equipped to provide care and advice.
John S Heintz, MD
Former Clinical Assistant Professor of Pediatrics
College of Medicine
The Ohio State University