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 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.

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

· 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 a

· 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





Appendix A: Link between Diabetes and Prednisolone



I found a solid link between Prednisone and diabetes. Google gave me a
number of search results:

a.. 1,270,000 for Prednisone diabetes.
b.. 372,000 for Prednisolone diabetes


Here are a few interesting links I found that seem to link Prednisolone to
diabetes:



http://www.diabetes.org/live/transcript.jsp?chatid=19

Question: My son is a Type 1 Diabetic. He has a rash on his arm that
continues to get worse. Originally we took him to his family physician who
prescribed prednisone which seemed to be helping the rash, however when he
visited his endocrinologist, he told us this medication was contributing to
his high blood sugars. He prescribed Ketoconazole (2 tablets) however it
still isn't any better, and seems to be getting worse. We call his Endo and
he suggested a dermatologist. I just wanted to know if you have any
suggestions or opinions.

ADA: We would agree that the prednisone can cause your son's blood glucose
levels to be elevated and since the antifungal (Ketoconazole) is not helping
the rash get better it would be in your son's best interest to be evaluated
by a dermatologist. A dermatologist is trained to treat conditions of the
skin and can consult with your son's endocrinologist to determine the best
treatment option for the cause of the rash without increasing his blood
glucose levels.



http://www.medinfosource.com/expert/exp4052702b.html

Q. I am a legal assistant in Missouri. I have a client who was given 40 mg
of Prednisone for swelling in his wrist. He started noticing harsh side
effects immediately Five days later he was diagnosed with Diabetes type 1.
One of Prednisone's side effects is diabetes, but it doesn't state what type
of diabetes it can cause. Have you heard of anyone having this same case?

A. Prednisone is indeed a powerful drug, and can be life-saving but must be
used cautiously. It is one member of the group of drugs commonly called
steroids or cortisone. As a group, they are the strongest form of
anti-inflammation medications available so common uses would include the
treatment of severe asthma, allergic reactions, and various strong
auto-immune diseases such as rheumatoid arthritis.

Persons taking these drugs on a long term basis are monitored for side
effects such as the development of ulcers. They do indeed interfere with
glucose (sugar) metabolism but this is usually not so severe. In rare cases
an acute case of diabetes can occur which requires immediate treatment as
you describe. Some of these cases will resolve if the Prednisone can be
stopped, but some cases persist. It is thought that the Prednisone has
unmasked a diabetic tendency when the condition fails to resolve.