May 8, 2012
Complications, Research: Cure
Question from Auckland, New Zealand:
My son has had type 1 since he was the age of 4 years, 11 months. He is now nearly 11. At the time of diagnosis, he was antibody negative and, as of his test of last month, remains antibody negative. We have his brother’s umbilical cord blood banked. Is there any way we could use this to reverse NON autoimmune diabetes? We have no family history of any kind of diabetes.
He has lipoatrophy from insulin (NovoRapid). He pumps untethered but every pump site gets a light infection (that can be squeezed out). His A1c when starting untethered on a pump five years ago was 6.9 and it has slowly crept up (a lot since changing to Humalog) to 9.2 and we can’t understand why. The endocrinologists are investigating MODY but feel it will be negative. Any advice on cord blood or anything else that might present as type 1 that isn’t would be great.
Answer:
Autoimmune type 1 diabetes only has positive antibodies about 60 to 80% of the time. When biopsies are done of the islets, however, there is autoimmunity virtually all of the time, with the exception the very rare monogenic diabetes patients. Usually, such patients present with a very distinct familial genetic pattern and/or extremely early age of onset. So, this does not quite fit a 4 to 5 year old onset description. You should review with your diabetes team to see what is causing the very high A1c levels on an insulin pump as this is most unusual without some obvious explanation. You should also review with them any other possible rare types of diabetes since they will also know what kinds of testing possibilities exist for your family as well.
SB
