From Buffalo, New York, USA:
Our 4 year old son was diagnosed one month ago with Type 1. He was discharged from the hospital on just 1/2 unit of NPH and 1/2 unit of R in the morning and 1/2 unit of R before dinner. He was taken off all R within a week after returning home, and one week ago, he was removed from all insulin because he had some low readings (40s and 50s). His doctors were concerned about his having a reaction and felt that it wasn't worth risking it for such a small amount of insulin. We recently got the results of his Islet antibody test. It was negative. Originally, a urine test at his yearly check up showed glucose and that is what made our pediatrician suspect something. Our son never had a single symptom--he wasn't sick, no increased thirst or urination or hunger--nothing. Our pediatric endocrinologist is 99.9% sure that he is diabetic and we believe her. However, are there other causes for increased blood sugar readings (off insulin this past week, he hasn't had a reading above 177) that we should be trying to rule out? Especially given the negative antibody test?
If your son has had significantly elevated blood sugars as well as sugar in the urine on a number of occasions then the diagnosis is almost certainly diabetes. Without knowing the exact details I can't be absolutely certain that this isn't a stress response; but a simple 2 hour test might confirm glucose intolerance, though I expect this has already been done.
There are however, a number of explanations for a negative antibody test in the presence of clinical diabetes. First of all, an occasional Type 1 case will initially be antibody negative at the onset and then develop antibodies after several months. Whether these cases represent a milder form of the autoimmune disorder has yet to be shown.
Also over half of the new onset diabetics in children from African American or Hispanic families will be antibody negative. In these instances there is usually a strong family history and again the diabetes is mild and doesn't require insulin. For convenience this is often called Type 2 Diabetes in childhood; but really it has not yet been defined in basic terms.
Finally there are a number of rare genetic disorders that are possibilities. These include the three known forms of Maturity Onset Diabetes in the Young (MODY), the mitochondrial forms of diabetes, and some ultra rare conditions like ceruloplasmin deficiency. I think you better ask your doctor to explain these; but my guess is that your son has Type 1 Diabetes and will ultimately require insulin again and be antibody positive. In the meantime I think it would be a good idea to do blood sugars occasionally especially when he is sick and also try not to be too anxious. Type 1 Diabetes can be a nuisance; but these days it can also be compatible with a very normal life.
Original posting 4 Aug 97
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Last Updated: Tuesday April 06, 2010 15:08:54
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