My 14 1/2 year old stepdaughter was diagnosed with Type 1 2 1/2 years ago. Other than the honeymoon period, she has never been in control of the diabetes. Her doctor told us this week that he thinks she might be a Type 2 diabetic due to the lack of antibodies in her blood test results. He is seriously considering starting her on Glucophage [metformin, a pill for Type 2 diabetes]. He has ordered another test that will take several weeks to get the results and he said this would let him know more. Her doctor stated that the “new consensus” was that about 50% percent of the children over 10 labeled at Type 1 are actually Type 2. I have never heard that. Is it accurate?

Additionally, my stepdaughter suffers from severe headaches when going into the sunlight and menstrual cycles which last for over a month at one time. Could these be related to her diabetes?

I think that the first point to make in responding to your question is that good control is far more important to your daughter than a precise diagnosis of the type of diabetes that she has. The issue of antibody-negative diabetes in childhood has recently attracted some attention. The figure of 50% is thought to apply only to Hispanic or African American children with an incidence in Caucasians of less than 10%. The commonest form of new onset diabetes in North America and Western Europe is now called Type 1A and is due to autoimmune destruction of the insulin producing cells. Treatment with insulin is at the present a lifetime obligation. Antibody negative or Type 1B diabetes is usually initially insulin dependent; but in approximately half the cases the need for insulin may cease after a number of months and these cases can then be kept in control on oral medication or even with diet and exercise alone. The exact basis for the diabetes in this group is not yet known although a small proportion have chromosomal abnormalities and there is no specific diagnostic test. HLA typing which I suspect is the test that your daughter’s endocrinologist is waiting for would help though; a positive for the protective gene 0602 would suggest Type 1B and a typical pattern for Type 1A would be helpful. Type 1B children are thought to be hypoinsulinemic so that ultimately many of them are likely to require insulin again. There are other forms of antibody negative diabetes that occur in the young including the MODY group; but usually here there is a significant family history and also there is seldom initial insulin dependence.

Metformin (Glucophage) is being used to try to achieve better control in Type 1A diabetics as a supplement to insulin, it is also being used in Type 1B Diabetics as a substitute for insulin.

I talked to our ophthalmologist about the eye problems and he thought that it was exceedingly unlikely to be due to diabetes although there is a very small chance of it being due to a cataract, something that is itself most rare at 14 years old with diabetes.

The menstrual difficulties are something to discuss with the endocrinologist, the usual treatment if they persist being low dose birth control pills or progesterone alone.

At this stage in life and particularly with girls there is great susceptibility to psychosocial pressures. So in searching for the cause of the headaches and the poor control I would suggest meeting with the social worker in the diabetes care team; if they are experienced with this age group they can often be wonderfully helpful. Apart from stress itself, other common causes of poor control are dietary aberrations that you may not know about and sometimes deliberate distortion of the insulin regimen which is could be a plea for help and sometimes an attempt to lose weight.

Finally, of course, the poor control may have a very simple explanation such as a nonoptimal insulin regimen especially too much insulin; but these are issues to discuss with the doctor.

DOB