Type 1 and Too Skinny   (September 5, 2011)

I received the following e-mail question:

My grandson is always hungry, eats huge amounts of food (which no one can afford). He is type 1, weighs 159 pounds, is 21 years of age and is 5'10".  What is causing this?  What can we do to correct the problem? He is skinny -- too skinny!  I heard one nurse say he may be ‘starving'."

My reply:

There's something wrong here. First, height/weight charts indicate 159 pounds is about right for a male who's 5'10" tall, so if you and a nurse are concerned that he's too skinny, maybe your grandson's height or weight is different from what you report?

If indeed he is too skinny for his height, there are several possible medical reasons why. You don't mention anything about his diabetes status: are his blood glucose levels and A1C near-normal, or way out of control? If way out of control, then the problem is inadequate diabetes control, and he needs further evaluation by an experienced diabetes team. Another thought is that he might have a condition called diabulimia -- a condition where teenagers deliberately omit insulin, which leads to subsequent weight loss.

Rather than assuming that his problem is his diabetes, there's a chance that his situation is due to another common disorder in people with type 1 diabetes: he may have hyperthyroidism. When the thyroid gland is overactive, it makes too much of the thyroid hormone that the body needs to regulate metabolism. Hyperthyroidism is often caused by a condition called "Graves' disease" in the US (named after Dr. Robert Graves) or "Basedow's disease" in Europe (named after Dr. Karl Adolph von Basedow). With this disease, the body's immune system tricks the thyroid into making too much thyroid hormone. The entire thyroid becomes enlarged and overactive.

Signs and symptoms of hyperthyroidism include weight loss despite a good appetite, feeling irritable and nervous, tremors, having an enlarged thyroid gland at the front of the neck (also called a goiter), inability to tolerate hot weather and increased ability to tolerate cold weather, palpitations and/or rapid heart rate.

From what you say, your grandson needs evaluation by an endocrinologist.