May 22, 2001
Diagnosis and Symptoms
Question from San Antonio, Texas, USA:
Four months ago, my 10 year old daughter was told she had type 1 diabetes after a positive glucose tolerance test, but when they did a specific test to check for type 1, it was not detectable. The doctor said she could just be early.
Her blood sugars have not been higher than 349 mg/dl [19.4 mmol/L], and an average is 90-130 mg/dl [5- 7.2 mmol/L] and a hemoglobin A1c of 7.1% on only 3 units of NPH in the morning. Now, her doctor has said that perhaps my daughter does not have type 1, and she wants her to stop her insulin to see how she does. I just can’t see stopping something that works her sugars don’t go higher than 149 mg/dl [8.3 mmol/L] and usually are 90 mg/dl [5 mmol/L] with insulin even though it is such a small amount.
Can you be glucose intolerant with mildly high sugars and still test negative for the type 1 test?
I am sure that your daughter does have diabetes at least in part because she still has what seems to be a slightly elevated A1c test. At this time however, it is not possible to say whether her very low insulin requirement is a reflection of the honeymoon period in or autoimmune diabetes or whether she might have type�1B diabetes in which, after a few weeks or months, about 50% of new onset cases can manage without insulin at least for some time and can be controlled with oral hypoglycemic agents or even with just diet and exercise.
If this is indeed autoimmune diabetes, then my own feeling is that she should continue with insulin even in such a small dose if only to avoid the distress of almost certainly having to go back on later. I suspect that the ‘specific test’ was an antibody test, and, if it was, I think you should ask the doctor for more details. If it was the simple screening immunofluorescent islet cell antibody test and the result was negative, then it does not entirely exclude the autoimmune form. If, on the other hand, she was tested for the full conventional battery of ICA512, anti- GAD, and anti insulin antibodies, and all of these were negative, then by definition she has type 1B diabetes. The treatment isn’t any different; but it should make you more confidant about discontinuing the insulin. There is of course some possibility that she has another less common form of diabetes like type�2 or the various forms of MODY (Maturity Onset Diabetes in the Young) for which there are again special tests, but, if the onset involved acute insulin dependence, and she is not overweight, these are unlikely.