Influence of Type 1 Diabetes on Childhood Growth and Development

Insulin dependent diabetes mellitus (Type 1 diabetes) can adversely affect the growth of children. Type 1 diabetes is characterized by total insulin deficiency. Insulin is an anabolic hormone that regulates the metabolic pathways that increase the synthesis of proteins, glycogen, and fat. Insulin activates a transporter system that moves glucose into muscle cells for the production of energy and into adipocytes for both the production and storage of energy. Clinical observations indicate that insulin deficiency is associated with growth failure and that hyperinsulinemia is accompanied by weight gain and accelerated linear growth (1). Insulin promotes growth by increasing the intracellular availability of substrate (glucose) for energy production, and also exerts an indirect effect by increasing insulin-like growth factor (IGF-1), which is the primary agent that stimulates linear bone growth (2). Because Type 1 diabetes is associated with abnormal insulin production and release, it is not surprising that growth irregularities have been associated with Type 1 diabetes in growing children. Type 1 diabetes is an endocrine problem precipitated by the total absence of insulin, which contributes to the associated hormonal abnormalities seen in Table 16.1.