Endocrine Abstracts

Iron is a transition metal that acts as an oxidant. There is evidence that systemic iron overload could contribute to abnormal glucose metabolism. Further research has showed that iron overload can result in an increased in type 2 diabetes irrespective of the cause of gene involved. Although the exact mechanism of iron-induced diabetes is uncertain, it is likely mediated by these three mechanisms: i) insulin deficiency, ii) insulin resistance, and iii) hepatic dysfunction.

Insulin stimulates cellular iron uptake through increased transferrin receptor externalisation. Thus, insulin and iron can mutually potentiate their effects, leading, after a vicious cycle, to insulin resistance and diabetes. Furthermore, a decrease in insulin resistance has been documented after iron depletion in type 2 diabetic patients. Majority of the current literature discusses the relation between high ferritin and type 2 diabetes but few describe the relation between elevated ferritin levels and type 1 diabetes.

In this novel case study, we question the significance of high ferritin levels and type 1 diabetes in an 11-year-old boy whose first presentation was with pain in his hands which worsen in hot weather and exercise. His high ferritin levels (300–630 μg/l) persisted and he presented again 7 months later with testicular pain and poor urinary stream and was reviewed by the Urologist. Four years later he presented with type 1 diabetes. To date he has displayed poor diabetic control and high ferritin.

In the UK, there is has been an increasing prevalence of type 2 Diabetes in children. We propose to monitor ferritin levels in this cohort of children as part of their annual review investigations.