From Hatfield, Pennsylvania, USA:
Please help me understand what is happening to my daughter who has had some recent changes. I just received her most recent endocrinology report and I must admit that I am feeling more confused then ever. It has been said several times that my daughter may likely be developing type 1 and that we caught it extremely early but now, given her new laboratory results, I'm not sure where she stands.
A bit of history...my daughter is a "non-diabetic" at present, but continues to be monitored by an endocrinologist due to positive diabetic antibodies which were discovered due to random and unpredictable hypoglycemic episodes. My daughter also has random and unpredictable (mildly) high blood glucoses. In May of 2006, she had the following test results: GAD-65 - 35 (normal range being less than 0.5); Islet cell antibodies - 3.2 (normal range being less than 1; and Insulin Autoantibody - 5.8 (normal range being up to 5).
Recently, she had some fasting blood drawn and these are the results: Glucose - 95 (normal); CO2 - 19 (slightly low); GAD-65 - greater than 30; Islet Cell Antibody - negative; Insulin Antibody - less than 1; C-Peptide - 0.7 (0.8 to 3.1) (slightly low); IGFBP-1 - 123.1 (20-105) and A1c - 5.2.
Can you please help me to understand what is happening? Why would two of her previously positive antibodies now become negative? Does this ultimately mean she now has a lowered risk for future development of type 1 or do the prior positive antibodies hold more ground because they were witnessed? Will they become positive again? Does it mean her pancreas is no longer under attack? How do the other results play into the big picture for my daughters future? I do not know what to think, nor do I understand what these other tests represent. I am really beside myself with all of this. Our next appointment is not for a few months away and I would greatly appreciate your professional opinions!
You should be asking these important, but complex, questions to your child's diabetes team. It is perfectly okay to call them, e-mail them or write them between appointments when something comes up that is troubling.
Antibody tests are notoriously fickle; they go up and down and often appear transiently, then become negative and sometimes become positive later on. If all this indicates an early antibody-positive phase of type 1 diabetes, then the pancreatic beta cells are probably in the process of "dying out." Sometimes, they just continue to secrete less and less insulin until there is hyperglycemia. If one waits long enough, then symptoms would appear, but it is theoretically possible to catch the high sugar phase without much symptom-wise. Occasionally, there are folks whose beta cells - while being damaged by the inflammatory process - probably over and then under-secrete insulin. Thus, there are episodes of hypoglycemia (overproducing insulin incorrectly) and then under-secreted insulin and eventually symptomatic hyperglycemia. From what you have described, without symptoms, but with high and low blood sugar readings, your child is in this phase. Scientifically, it is not clear what should be done. Some would suggest a small dose of insulin to "save" the damaged beta cells from over-working. There is some research from Aoki and Soeldner, as well as Malone, about such an approach. Others would just watch carefully with frequent blood glucose monitoring and awareness of symptoms for a clue as to when insulin should be started. I, personally, usually watch blood sugar levels carefully and without any symptoms watch to see what develops while recommending carbohydrate avoidance as a means for "resting" the beta cells; if insulin has already been started, then I usually continue insulin even if only very small doses with the meal plan as above.
Original posting 22 Apr 2007
Posted to Diagnosis and Symptoms
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Last Updated: Tuesday April 06, 2010 15:10:12
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