Dr. Stuart Jay Brink

Personalities sometimes change as kids move into and through puberty, but usually somewhat more aggressive with boys getting more testosterone. If you know something about what others in the family tree experienced, this may provide a better clue so unlikely hormone related directly. Other issues in adolescence sometimes also show up more anxiety or depression, but often there were some subtle signs of these earlier on. But lots of variability. Would be reasonable to discuss with his pediatrician and perhaps even with some teachers or coaches who know him as well. If you have concerns, the getting a more formal evaluation may help.

Stuart Brink, MD

Lots of research trying to cure or reveres type 1 diabetes, but no such luck yet. Key remains lots of education and monitoring to learn about food choices, carb counting, activity adjustment, optimizing insulin administration and to consider insulin pump and continuous glucose monitoring as the best treatment options at the moment. Best teaching manuals: Hanas' Type 1 Diabetes and Chase & Maahs' Understanding Insulin Dependent Diabetes.

Stuart Brink, MD

Most 8-year-olds who are overweight or obese don't buy their own food and snacks, so key will be to determine what you are offering and what is available at home for meals and for snacks. Much more water is always a great model to help you as parents with your weight, but also to demonstrate this option for your child. Paying particular attention to the amounts of carbohydrates (cereal, pasta, bread, potatoes, fruits/juice, candy) is another great idea to consider. Decreasing size of plates helps to decrease simple excess portions as well. If you don't know how to get started, then sitting down with a pediatric dietician/nutritionist recommended by your PCP or pediatrician is another good option. And, of course, in addition to cutting total grams of carbohydrates/sugar intake and perhaps also saturated fat/total fat intake, increasing daily activity/cutting down on time on the phone/computers/television can only help the process. If not already done, then blood vitamin D levels (goal should be >50 ng/ml levels optimally), as well as lipids (total cholesterol goal <170, HDL goal >50, LDL goal <100, nonHDL cholesterol goal <100, triglyceride goal <84). The more these are abnormal, the greater the current risk as well as future risk. Overall end goal is to decrease current and future risks of diabetes, high cholesterol, high blood pressure, osteopenia/osteoporosis (and maybe also cancer) that is all reflected with excess weight, excess carbs.

Stuart Brink, MD

Excess hypoglycemia often results from mis-matched insulin, food and activity when someone has type 1 diabetes. Key is getting on a stricter schedule to match these up and having more up-to-date information about carb counting, glycemic index, lot of BG testing and analysis to look for patterns. Important to review this with your son's diabetes treatment team
to see if they have specific suggestions since they will know him individually. Also, it's important to make sure your son's education about his diabetes is up-to-date. Best books ares the Pink Panther Understanding Insulin Dependent Diabetes by Chase and Maahs and the Type 1 Diabetes manual by Hanas; both can be purchased on line or special ordered through any bookstore.

Often, changing to a more "aggressive" multidose insulin (MDI) regimen will also help, sometimes switching to a different type of basal insulin (i.e., more stable basaglar so fewer peaks and valleys of insulin). Sometimes changing times of dosing. Insulin pumps especially associated with continuous glucose monitoring systems (CGMS) like the Medtronic 670G and Guardian systems talk to each other and identify hypoglycemia automatically, send alarms and even respond in advance of hypoglycemia to help minimize or prevent low sugar levels. This options also should be discussed with the diabetes treatment team, too. The more severe the hypoglycemic events and the more frequent they are occurring, the more urgent to update the information for the family and to have these discussions with the diabetes treatment team.

Stuart Brink, MD

Fluid intake is very variable from one individual to another and also depends upon exercise, outside temperatures, and saltiness of foods. With diabetes mellitus (sugar diabetes), the high sugar levels in the blood get processed by the kidneys and "pull out" water so there is more urination. The thirst is normal and responds to the loss of this extra fluid, so drinking too much and urinating too much (day or night including enuresis for little kids) becomes a symptoms of possible diabetes. There is also another kind of diabetes called DI, diabetes insipidus, and this reflects a problem with a pituitary hormone that also controls thirst and urination, but is not linked to blood sugar levels. Unexplained weight loss associated with increased urination and/or thirst also would be worrisome. Usually, kids do not drink more water than adults, so it would be helpful to have your child's doctor check a urine sample and perhaps consider some salt levels and sugar levels accordingly.

Stuart Brink, MD

The question is a bit confusing since overactive thyroid problems, called hyperthyroidism or Grave's Disease, are associated with unexplained weight loss as the entire hormone system is in overdrive. Both hypothyroidism and hyperthyroidism can be associated with irregular periods, however. Low-carb eating isn't directly related to either over- or under-active thyroid problems. But, with any weight excess, cutting back carbs allows the body to use less insulin and that combination can be associated with easier and significant weight loss for many people.

I'd also advise going back to your physician and medical team to review whether you are talking about hypothyroidism or hyperthyroidism.

Stuart Brink, MD

Juvenile diabetes is more recently named type 1 diabetes. Also, insulin dependent or autoimmune diabetes mellitus. All indicate a relatively younger age of onset, not directly associated with obesity (as in type 2 or non-insulin dependent diabetes mellitus), associated with positive blood antibodies against the pancreas (islet cell antibodies [ICA], GAD65
antibodies [GAD65], IA, Zinc transporter 8 [ZnT8] antibodies alone or in combination and often also associated with other autoimmune problems like thyroid [Hashimoto's thyroiditis, hypothyroidism,hyperthyroidism], adrenal [Addison's adrenal insufficiency], gastroparietal antibodies [pernicious anemia, B12 and folic acid deficiency], gonadal antibodies [testosterone or ovarian hormone problems] as well as celiac disease [transglutaminase, endomysial or antigliadin antibodies]). We believe these are influenced by a genetic tendency especially in the HLA region of the genes, which is inherited - so there are higher family risks - but then something in the environment (chemicals, viruses, other factors) that interact with these genetic factors that allow the auto-attack on the insulin producing beta cells in the islets of Langerhans in the pancreas. If enough damage occurs, then insulin is no longer sufficiently available and blood sugar (glucose) levels rise and then the symptoms of diabetes and all the long-term complications occur if insulin cannot be delivered and balanced against food, activity, growth needs correctly.

Symptoms arise from insulin deficiency, sugar levels rise, the body tries to get rid of the excess sugar by producing more urine. Then the body gets progressively more dehydrated from excess daytime or night time urination: more thirst, large amounts of urine produced, enuresis, vaginal or bladder infections especially yeast infections, unplanned weight loss from the excess water loss, then excess loss of sodium salt and eventually the body tries to provide lost energy from its fat stores. This produces ketones as the excess fat is burned off and further weight loss occurs. If still undiagnosed or recognized, then excess body acids can be formed and this can produced diabetic ketoacidosis (DKA) and lead to death ... all of these symptoms are not recognized and treatment to replace the missing insulin is not available or not begun.

Stuart Brink, MD

No set age. It mostly depends on symptoms you might notice: excess thirst, excess urination, new onset of bed-wetting, vaginal/yeast infection, unexplained/unintended weight loss, fruity odor to breath (ketones), excess weight, acanthosis nigricans (darkened, raised skin in the neck, armpits, groin area, under breasts), etc. In certain genetic conditions, such as Down Syndrome, Turner Syndrome, and Klinefelter's Syndrome, diabetes is also more common and should get periodic checks also. You should discuss with your pediatrician or family practitioner since they may routinely do urine testing that also checks sugar levels.

Stuart Brink, MD

Could be a thyroid, adrenal, or growth hormone problem. Have your doc do a complete physical exam and history and perhaps consider thyroid function testing. Actually, writing down 4-5 days of exact foods and snacks including amounts and getting specific calorie totals will answer if there are too many calories being eaten, as that is the most common explanation. Apps such as Lose It are excellent and can be freely installed on your mobile phone to help get this done.

Stuart Brink, MD

First 6-12 months of periods can cause cramps, irregular flow, and breast tenderness as the hormone levels fluctuate. Same for mood swings, especially if there is some underlying depression, anxiety, or sleep problems. If you are concerned, best to discuss it with your primary care providers. If this persists, often low-dose birth control pills can balance these hormone swings.

Stuart Brink, MD

No long-term studies with stevia, but it seems well-tolerated and perhaps a bit better then some of the other artificial sweeteners. Biggest problem with all of them is that they may contribute to "carbohydrate craving" that so many people have. Water, plain or bubbly, is probably the best choice, and some of the flavored waters without any artificial sweeteners also are an option. Good to try it out and also to discuss with your diabetes team to get more individualized advice.

Stuart Brink, MD

There actually are several hormone related explanations for obesity besides slow metabolism, usually on a familial basis. Some others that are specific genetic conditions such as Prader Willi Syndrome. Hypothyroidism, low thyroid hormone output, is often associated with weight excess. Usually goes along with being cold all the time, more fatigue, slow height gain associated with excess weight gain, coarse, poorly growing hair and fingernails, sometimes milk discharge from breasts in teens or adult women, slow pulse, lower blood pressure, poor reflexes. Sometimes also an enlarged thyroid gland called a goiter. Once this is considered, then easy to diagnose with blood levels of thyroid and pituitary hormone TSH that controls the thyroid hormones. Most common explanation is an autoimmune attack/inflammation called Hashimoto's thyroiditis that makes the thyroid gland underactive. If treatment is necessary for confirmed hypothyroidism diagnosis, relatively simple thyroxine hormone pills once a day correct the deficiency.

Other conditions can be associated with an underactive pituitary system where the TSH itself is insufficient, therefore, the thyroid gland is under-stimulated. Can occur (rarely) alone or more often in association with other hypothalamic or pituitary insufficiencies from tumors, cysts, radiation to the region, surgery to the region, trauma to the region. If other hormones (ACTH, GH, TSH, LH, FSH as well as problems with posterior pituitary causing diabetes insipidus as well as abnormalities of MSh and Prolactin) are involved, then growth hormone can also be deficient or insufficient.

Growth hormone deficiency is also associated with weight excess. In kids still growing, then height gain will be too slow associated with weight gain. Specific testing can be done with blood work, bone age X-rays and MRI of pituitary region to help sort this out. If GH deficiency is diagnosed, GH is available to correct the situation and the associated weight excess
usually goes away.

Adrenal cortisol hormone excess (Cushing's) also associated with significant weight gain/obesity also with decreased height. Can be a problem of the adrenal glands themselves or from getting too much cortisone, prednisone or dexamethasone used usually for anti-inflammatory treatment of a variety of illnesses. If not from medication, then blood hormone levels of cortisol and pituitary ACTH can help make a diagnosis. Also will need ultrasound or MRI of adrenal regions themselves as well as pituitary accordingly. Treatment once diagnosis is made, is specific for source of the problem that explains the excess and could be medication, surgery, etc.

So, the answer to the question is a bit complicated. Good history and physical exam and review of plotted wight and height data on charts most often allows consideration of possible diagnostic possibilities and consideration for referral to an endocrinologist for consultation and treatment.

Stuart Brink, MD

Sadly, no known cure for type 1 (juvenile onset) diabetes. Lots of research people working on this for quite some time, so nobody knows when some of this research will produce a "cure." However, there is excellent new insulin and ways to deliver it with insulin pumps now connected to continuous glucose monitoring and semi-automatic insulin delivery by these
pumps. You should be active and learn as much as possible, read Ragnar Hanas' Type 1 Diabetes manual as well as the Chase and Maahs' Pink Panther manual since they have excellent information. ADA, JDRF, ChildrenwithDiabetes, Diatribe are also excellent websites to explore and there are excellent camping programs for kids with diabetes worth
considering, too.

Stuart Brink, MD

Short stature is often a familial pattern, so a large degree of genetics involved. Most important if this is not an obvious family pattern, would be to have a complete physical examination and detailed systems review. Conditions like Turner and Noonan syndrome can be associated with short stature and both respond to growth hormone treatment very well. Some other genetic conditions also are associated with short stature. Other problems such as thyroid, adrenal, pituitary and hypothalamic difficulties need some evaluation usually by lab testing and most often with consultation with a pediatric endocrinologist experienced in these ares. Celiac disease also sometimes presents not only with stomach and gastrointestinal complaints, but also short stature and there is a simple blood test to screen for this as well. The key is looking at growth data, evaluating this information with a
thorough exam and history, and then getting appropriate X-rays and blood work to try to determine the cause. Should be evaluated by your primary healthcare provider, and then ask about a consultation with the nearest pediatric endocrinologist.

Stuart Brink, MD

No problem with diabetes and sports. Like everything else with diabetes, though, you (and he) need to learn what activity is expected to do to BG levels and, most importantly, how to counter-balance. Working with your diabetes team should help you achieve this. We always want to encourage active sports participation for all the physical and also social/emotional benefits of being with peers and being active. A great book is Ragnar Hanas' Type 1 Diabetes that has lots of information about sports participation. Same with Chase & Maahs Pink Panther manual.

A bit unusual. Could be hypoglycemia - low blood sugar levels - in which case you should talk to your son's physician and have him examined, perhaps also get a home blood glucose meter and check the actual sugar levels at the time that he is hungry and/or sweaty. If the glucose levels are below 60, treat this with 4 oz of orange or other juice and should rise. Then call the doctor to let them know. If all the time he has hungry symptoms and/or such sweatiness, the glucose levels are above 70, then this is not related to low sugar levels.

Simple answer is no. But, if eating extra sugary foods/snacks leads to obesity then it is the overweight situation that can overwhelm the pancreas and be associated - but not causing - diabetes.

Easiest way to control the sweets and chocolates is don't purchase them so that they are not in the house. Same for sugar containing drinks, juice etc.

The "short" answer is yes. But most height issues have a strong familial/genetic pattern so important to know about patterns of growth for the parents and grandparents to see if this is similar or dissimilar. Are there others in the family who were short or went into puberty later but then spontaneously caught up and could this be a similar benign pattern? A detailed history of pregnancy, birth weight and length, review of growth charts look for patterns. Same with a detailed history of other problems (celiac disease, underactive thyroid, for instance) and comparison between weight and height percentiles. Then detailed physical exam looking for conditions like Noonan Syndrome or others associated with short stature in boys. Then looking at a bone age xray to compare actual height and bone age plus some screening laboratory tests like IGF-1 and others that help sort out some subtleties. Finally, following height and weight every 3-6 months and plotting on the charts to see if there is any pattern or change that may require consultation with a pediatric endocrinologist for more specific evaluations. Special growth hormone stimulation testing is sometimes needed to help sort this out as well as brain MRI of the pituitary and hypothalamus regions where hormone are controlled.

The short term complications of type 1 or juvenile diabetes are mostly related to illness when something called DKA, diabetic ketoacidosis, can occur. This can almost always be prevented by regular blood glucose monitoring and learning about sick day guidelines to take extra insulin and extra salty fluids to compensate for dehydration. Mostly caused by the illness requiring more insulin and no increased insulin response.

Hypoglycemia is another potential problem with anyone getting insulin. This is from a mis-balance of food, activity and insulin. Again, monitoring BGs closely and responding to the results can often identify hypoglycemia early so that it can easily be tread with simple sugar like juice or Lifesavers or glucose tablets.

Long term complications take years to develop, are associated with chronic high sugar levels (hyperglycemia) and high A1c levels which are a measure of this hyperglycemia. The high sugars, over time, damage the blood vessels of the eyes, kidneys, heart, brain, kidneys and general circulation. So, the high sugars do similar damage to smoking, high cholesterol, obesity, high blood pressure. Some people have a higher familial/genetic risk and we do not know how to measure this directly except by asking about family diseases. In diabetes, this reflects the degree of glucose control achieved an sustained. The better the control, without excessive or severe episodes of hypoglycemia, the lower the shrot and long term complications, so that's the key.

There are no height increasing supplements despite the adds to the contrary - unless there is a hormone deficiency such as a growth hormone insufficiency, underactive thyroid or problems with ovaries or testicles where estrogen or testosterone ar not being produced. Similarly, there can be problems in the controlling factors in the brain hypothalamus and pituitary areas hormone. And it depends on the cause of the short stature, whether this is just a delayed benign pattern that others in the family have had and that will self-correct; or a genetic problem such as Turner Syndrome or Noonan Syndrome. Or a late effect of having been born small for gestational age (SGA). all of these respond to growth hormone treatment just the same as if there was overt growth hormone deficiency. So, lots of medical detective work to get family history, past history for the child in question, and review of detailed height and weight charts to look for patterns and clues. Then some X-rays like a hand bone age or some pituitary MRI studies. Then some blood tests looking for subtle problems that impact growth and growth rate, but most importantly, close follow-up with height and weight plotted every 3-6 months to be more aware of what is happening, correcting, worsening, or staying the same. If still questions, then a consultation with a pediatric endocrinologist will help sort most of these issues.