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February 2, 2006

Diagnosis and Symptoms

Question from Farmington, New York, USA:

After five months and tons of testing, my son was officially diagnosed with type 1 diabetes. The reason it took so long was the unusual presentation. His body is still producing insulin, just not enough to keep his blood sugar at a normal level. The last time we did a serum insulin level, his blood sugar was 217 mg/dl [12.1 mmol/L] with a insulin level of only 24.8. His blood sugars do eventually come down, but it takes up to five hours to get back to "semi-normal." We started my son on NovoLog only because his endocrinologist feels that his A1c is still well controlled (5.7), and something like Lantus would make him too low. Right now, we're only doing one half a of NovoLog just to get a feel and make sure it doesn't make him too low because his body is still somewhat producing insulin. He's five years old and only 40 pounds at 43" tall. He really hasn't gained weight at all since being diagnosed. There isn't much research or information out there on Latent Autoimmune Diabetes in Children, but his endocrinologist is sure that's what's going on, only because we have seen a slow increase in blood sugars, readings and a decrease in insulin levels (last time he was 36 with a 139 mg/dl [7.7 mmol/L]). He did have an Islet Cell Antibody test back in September, but it came back negative. The next time he has blood work done, his endocrinologist is going to order one because he think's it'll be positive now. However, I have read there is a percentage of type 1 diabetics that had negative antibodies, so I'm not 100% convinced. Does this sound like a Latent Onset type 1?

Answer:

You are correct that not all antibody test results are definitive. Your child’s clinical course over the next few years will likely help you to know better whether this is a common or unusual type of diabetes. For example, how easy or difficult is it to control the blood glucose levels on a day to day basis will help with this determination. Whether one uses a fast acting analog pre-meals or basal insulins (overlapping NPH and/or Lantus), should depend upon blood glucose readings.

SB