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June 26, 2010

Diagnosis and Symptoms

Question from England:

My son was diagnosed with type 1 in 2003. He had mild ketones at diagnosis and had lost a lot of weight. He has done very well since. In 2005, he had a very low HbA1c of 5.1. His consultant at that time checked my son's C-Peptide, antibodies and, I think, serum insulin (there was not enough blood in the sample). There was some talk of him coming off insulin for a trial in hospital but we moved and this didn't happen. His new consultant has done a C-Peptide twice but only the last as fasting. These are the results: January 2005 - 415 (I don't have the normal range); September 2008 - 230 pmol/L (normal range 298 to 2350); and September 2009 - fasting C-Peptide of 65.5. The new consultant has now taken blood to re-check for antibodies (now back as negative for four types) and would then like to do a trial off insulin for 24 hours to re-do the C-Peptide. He has also mentioned halving his insulin and trying Metformin. We do have some autoimmune problems in the family. I have psoriasis, My son's dad has asthma and hay fever, My son has hay fever as does my dad. My mum's brother has rheumatoid arthritis. Two of her brother have/had type 2. My son's dad is Nigerian by birth (Yoruba) and I have read a little about African American Children being classified as having type 1b. We are not too sure of the family history due to scanty records, polygamous marriages, etc., but we are unaware of anyone else with any type of diabetes At the moment, my son is taking 68 units of NovoMix. He weighs 84 kg (185 pounds) and is 187 cm (6 feet, almost 1 inch) He once had an HbA1c of 7.8 but the rest of the time it has been about 6. He has never become unconscious or had seizure. What is your opinion of his situation?

Answer:

It is difficult to know for sure. NonCaucasians still can have type 1 autoimmune diabetes but less so than Caucasians. Antibodies, if negative, are not very helpful since antibodies are only positive 60 to 70% of the time at diagnosis and less so over time. With close blood glucose monitoring your diabetes team can slowly taper insulin and watch results closely to decide.

SB