February 21, 2006
Diagnosis and Symptoms
Question from Swanage, England:
My four year old daughter was diagnosed with type 1 diabetes at the beginning of October 2005. She has continued to need a very small amount of insulin, approximately four or five units per day of Mixtard 30, and has been pronounced to be in a “honeymoon phase.” She frequently has hypoglycemic reactions even though we adjust insulin accordingly and test her blood sugars four times a day or more if she looks or acts unwell. We have been told quite firmly that she is not type 2 as she is not overweight, but does this always have to be the case to be a type 2? She has also had a routine blood test done on the day of diagnosis, and three months after, to prove that the antibodies are there which should be present if she is indeed a type 1 diabetic. These tests have come back negative twice now. We are currently waiting for another blood test to come back. Apparently, they are now performing a full antibody screening test. If still negative, a MODY test will be done? What is this? I thought that type 1 diabetes was an autoimmune disease and now it seems that the cause could be something other than this? Is this correct? Or, does it sound more like she has type 2? I just want to know what was the cause of this diabetes, after all once we know the cause, surely we can better treat it.
Answer:
Diabetes in youth is generally, in at least in 80% of Caucasian children, autoimmune and autoantibodies might be negative in 20% of all cases. The rest of cases are monogenic (such as MODYs) or part of a complex syndromes, but these are actually very rare. Type 2 diabetes, generally in those who are overweight, is becoming more and more common also in children. Thus far, non-Caucasian children are genetically more prone to it. MODY2 in children (the most common form in young age) is generally asymptomatic with only modest hyperglycemia. In your daughter’s case, I’m wondering whether the residual endogenous secretion of insulin has been already evaluated in order to confirm type 1.
MS
[Editor’s comment: See a previous question on a similar subject. For more information on MODY, see Monogenic Diabetes:MODY.
BH]
