Have there been many cases of children diagnosed with type 1 recently who are later re-diagnosed? My 14 tear old son was diagnosed 15 months ago with type 1 diabetes by a doctor who told us there was no chance that his diabetes was reversible or temporary. This week, after new lab tests and following a month of very low blood sugars and no insulin, a different doctor told us that our son is producing insulin. Have you seen similar cases? If so, has the diabetes recurred later on? Does anyone know what can trigger this type of diabetes?

The great majority of new onset cases of diabetes in children in North America that require insulin are due to a disorder of the immune system that slowly destroys all the insulin producing cells. This is called type�1A or autoimmune diabetes and requires insulin for life. About 5% of the subjects who present like this in Caucasian families, but just over 50% of those from African American or Hispanic families have a different form of diabetes called type�1B. The two groups can be differentiated at the outset by an antibody test which is positive in type 1A and negative in type 1B. This is quite an expensive test so that doctors tend to wait and see because the initial treatment of the two groups is exactly the same. In type 1B, however, the type which I think your son must have, about 50% can manage without insulin after a variable number of weeks or months. They may continue to need oral hypoglycemic agents to keep in good control, but others may manage with just diet and lots of exercise. The underlying pathology of this second group is not yet well understood, although some are known to show chromosomal changes. There is very little data to judge the long term prognosis. What there is, however, suggests that there is an underlying insulin deficiency and that at some time in the future it may again need to be given.

DOB