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July 11, 1999

Diagnosis and Symptoms, Insulin

Question from a physician in Louisiana, USA:

For a newly diagnosed Type IA diabetes patient, is it necessary to send certain laboratory studies before giving exogenous insulin? What other studies aside from ones available in any typical hospital lab are recommended at the time of diagnosis?


From: DTeam Staff

I imagine that you will get quite a wide spectrum of answers to your question. I can only speak for my program by saying, first of all, that if the history, physical examination and blood sugar data justified a diagnosis of IDDM, we would give exogenous insulin and start the education process without further delay. At the same time we would order an antibody test, actually the three antibodies anti-IAA, GAD and ICA512. These results would hopefully confirm Type 1A; but in addition and admittedly because it is available as part of a research project we would ask for antitransglutaminase as a celiac disease marker, a test that is turning out to be positive in about 10% of cases and also for an anti-21hydroxlase level. This is positive in <2% of cases and provides an additional marker of the Autoimmune Polyglandular Syndrome and a useful forewarning of possible subsequent adrenal failure. Routine thyroid testing is not usually done until control is established. DOB Additional comments from Dr. Robertson: None. Of course what tests (other than blood glucose and perhaps a baseline HbA1c) you choose will depend upon your views on screening for other autoimmune disease, etc. In any case, such extra tests can be done at any time. KJR Additional Comments from Dr. Marco Songini Not for a routine patient. Only if you're joining a trial or a study then you should follow the proper protocol that, depending upon the specific aims, include exams or investigations that are not performed in a typical hospital setting. MS