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October 13, 2001

Research: Causes and Prevention

Question from Mansfield Center, Connecticut, USA:

About two months ago, my 19 month old daughter was diagnosed with type�1 diabetes, and the results of antibody test at that time showed high levels of anti-insulin antibodies, but low levels of ICA. What is known about anti-insulin antibodies? Is there anything that can be done about this? Is there any way to know if her pancreas is still working? Would this be a better situation if she is producing antibodies to insulin instead of ICA?

Answer:

Your question is rather beyond an e-mail answer, but I’ll try! First of all, the positive antibody test indicates that your daughter has type�1A (autoimmune) diabetes which is due to having a certain inherited pattern of proteins (HLA types) on the cell surface which combines with a so far unidentified environmental factor to sensitise certain white blood cells, CD4 and CD8 lymphocytes, to regard beta cells as ‘Foreign’ and to slowly destroy them.

The anti-insulin antibody that was positive is one of three that are conventionally measured (i.e. anti-insulin, anti-GAD65 [Glutamic Acid Decarboxylase], and anti-islet cell antibodies [ICA512]). Apart from diagnostic value, these tests are mostly used to estimate risk and time to insulin dependence in first degree relatives. The antibodies are thought to reflect islet cell damage and not to be the cause of it. The relative concentrations of the three forms is not important to management except perhaps in differentiating the two forms of Late-onset Autoimmune Diabetes of Adulthood (LADA).

The evidence is that insulin producing cells are completely destroyed over time, and because of this, it is not practise to follow the level of residual hormone, but there are tests that can be used to do this. The most common is a C-peptide level, a measure of endogenous, as opposed to injected, insulin.

DOB