Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
July 20, 2011
Diagnosis and Symptoms
Question from Gazvin, Iran:
My son was diagnosed with type 1 four months ago. At diagnosis, his C-Peptide was 0.05 and all the auto-immune antibodies were negative. Doctors advised us to re-check the antibodies since they were sure that one antibody must be present to cause the type 1 diabetes. Currently, the GAD and anti-islet cell are under examination again. Now, after about four months, he is taking only 3 units Lantus plus 1 unit NovoRapid while showing great improvement in his own insulin production. Is it possible to have type 1 diabetes without any autoantibodies? For someone recently diagnosed with type 1, such as my three-year-old son, what is the best I can do to treat or improve (re-growth) his islet cells and insulin producing cells? About a month after diagnosis, he was able to stop getting insulin injections for a week, but, after that, again started needing injections. If we consider that one week period as his "honeymoon period," what is the condition he is having now? Can it be honeymoon or not? It is important because if it is not honeymoon period, his dependency on insulin is really very minimal and showing some hope. Should we have his C-Peptide level checked again or not? Are there any other tests my son should have? I have consulted many doctors, but they just have not been very helpful. Can you give me hope? I am ready to travel anywhere in the world to find treatment for my son.
Most of us think that antibody testing is extremely expensive and not terribly helpful to answer your types of questions. Most three-year-olds with new diabetes have type 1 diabetes and require insulin for life. There are some experimental approaches to “curing” diabetes that mostly work in animals but are not yet acceptable for people because of unproven benefits and potential side effects. Antibody levels are only positive about 70% of the time in most children with classical type 1 diabetes and even less so in three-year-olds than in older children or adolescents. So, if positive, this confirms type 1 diabetes mellitus. If negative, it does not eliminate this possibility. Most of us do not stop insulin even in the honeymoon period but lessen the dose according to blood glucose readings, activity and eating. We provide small doses of insulin so that no insulin allergy develops and perhaps also to help rest the damaged beta cells of the pancreas. The younger the child, the less likely that the honeymoon period will occur and the shorter the honeymoon period at all. The best advice is to give optimal insulin using a multidose insulin (MDI) approach with the new analog insulins, flexible carbohydrate counting food and snack program and frequent blood glucose monitoring before and after food so that you are aware of the ups and downs of blood glucose levels each day – and learn how to respond with insulin and/or food changes accordingly. This requires detailed teaching and a systematic way of analyzing the blood glucose data (logbooks, computers, etc). For many, an insulin pump provides optimal flexibility but at high expense. MDI works quite well using Lantus or Levemir as basal insulin once or twice-a-day plus Humalog, NovoLog or Apidra as bolus insulin. Frequent monitoring of A1c also provides feedback on how you are doing. Staying in close contact with your pediatric diabetologist is critically important. The two best teaching manuals to learn about all of this are Understanding Diabetes, 12th Edition by Dr. Peter Chase and Type 1 Diabetes: A Guide for Children, Adolescents and Young Adults — and Their Caregivers by Dr. Ragnar Hanas, both available via the Internet.