13 year old lad diagnosed to have type 1 diabetes at the age of 18 months, moved to our area when he was about 5 years of age coming from a family with complex social background. His diabetes control has always been challenging with HBA1c generally above 70 mmol/mol and only occasionally going below 70. He was tried on multiple daily insulin (MDI), then insulin pump and then back to MDI currently he is on Insulin degludec. He had recurrent admissions to the paediatric ward with tonsillitis and eventually had a tonsillectomy done. Subsequently he had multiple admissions with headache. He had lumbar puncture done to exclude idiopathic intracranial hypertension which was ruled out, later diagnosed to be migraines. He was initially on antimigraine prophylaxis with reported good effect and later came off this. He then presented with recurrent lower abdominal pains and eventually had an appendicectomy done histopathology of which showed non inflamed appendix. After a brief period of convalescence, he again represented with recurrent abdominal pain. He was noted to have persistently elevated creatinine with intermittently raised urea. Ultrasound abdomen and kidneys done showed normal kidneys and atrophic pancreas which was later confirmed by MRI. He was diagnosed to have chronic pancreatitis and was identified to have heterogeneous variant detected for SPINK 1G which is believed to have caused the acute on chronic pancreatitis. He has been started on selenium ACE. His faecal elastase was normal, however if he presents again with recurrent abdominal pain he would need review for exocrine pancreatic insufficiency. This young man has been challenging due to the complex family background, cared for by single mother with two other boys with challenging needs, tendency of mother to medicalise the boy and perhaps exaggerate symptoms with varying history to multiple professionals and the lad not that unwell each time he presented. Possibility of fabricated illness (FII) was and is still being considered but with the new diagnosis of chronic pancreatitis, this has now been put in the background though still being monitored. He is now diagnosed to have chronic kidney disease stage II.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes