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October 24, 1999

Diagnosis and Symptoms

Question from Buffalo, New York, USA:

I am 28 years old who was just diagnosed with diabetes. My mother (age 61) has had it for three years. She had pancreatitis about 20 years ago. My father (deceased) was diagnosed with it at age 40. He was an alcoholic whose pancreas was calcified as a result of his heavy drinking. Also, my paternal grandmother, an uncle and two aunts on my father's side and an aunt on my mother's side all have it (all Type 2's). My wife is 8 months pregnant. She has it in her family too (only one living grandmother, 75; no other family history). My question is this: once our baby is born, at what age(s) and how often should we have our child checked for diabetes? My understanding is that beta cell destruction happens gradually over a period of years. Is there any way to test pancreas cell destruction levels without sugar testing? In other words, is there any way to verify that my wife's pancreas is still okay, or that it is in the process of destroying beta cells now? (I mean after she has the baby and is no longer pregnant to rule out gestational diabetes).

Answer:

To answer your second question first, the standard test for assessing the ability of the beta cells to make insulin is called an IVGTT test, that is one where serum insulin levels are measured 1 and 3 minutes after the intravenous injection of a standard amount of glucose. It would however be inappropriate for your wife to undergo such a test firstly because the family history suggests that she has a risk of developing Type�2 diabetes that is only marginally greater than for the population as a whole and secondly because Type 2 Diabetes is in any case initially usually a disorder of insulin resistance and not of insulin insufficiency.

On the second question, it would be important to know whether you yourself have Type�1A (autoimmune) diabetes or some form of Type 2 Diabetes and you should perhaps ask your doctor about getting an antibody test done. In the former case, the baby would have about a 6% chance of developing Type 1A diabetes in the first 20 years of life. A number to call for more information is 1-800-425-8361.

From the rather strong family history of diabetes on your side, though, I would suspect that you have Type 2 Diabetes and that in consequence the chances of the baby developing the same form in childhood would be sufficiently small as not to justify any routine testing. The same would hold true for some rarer forms of non-insulin dependant diabetes where specific diagnosis is cumbersome and not really relevant to treatment. You need to be sure that the baby’s pediatrician knows about your family history and for your own peace of mind, even if development is entirely normal, you will probably wish to test the child for glucosuria occasionally with a test strip in the diaper.

DOB