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March 31, 2003

Diagnosis and Symptoms

Question from Fremont, Nebraska, USA:

My nine year old daughter was diagnosed with type 2 diabetes about six months ago and has been on metformin. Recently, she was taken off the metformin because we were trying to get her into a study on a different medication and had a round of blood tests to determine her eligibility. As part of this, her doctor ordered another antibody test because she had lost some weight (prior to diagnosis she had gained nearly 20 pounds in three months). Well, the test came back that she had a "fair amount" of antibodies, and now they tell us she has type 1 diabetes. We go to the doctor in three days to learn how to give insulin injections. I am confused about the sudden change in diagnosis and wonder if we need a second opinion. Can you help me?


For many years, it has been the practise to divide diabetes into two broad types. Type�1 which occurred in young people and which required insulin and type�2 which was more an affliction in the middle aged, albeit increasingly seen in children, and was linked to being overweight and which, to begin with, could be contained by diet, exercise and a variety of drugs. A recent report has reminded doctors that this oversimplified clinically based diagnosis is often incorrect. (See H. Borg, H. J. Arnqvist, E. Bj�rk, J. Bolinder, J. W. Eriksson, L. Nystr�m, J-O. Jeppsson, and G. Sundkvist Evaluation of the new ADA and WHO criteria for classification of diabetes mellitus in young adult people (15 34 years) in the Diabetes Incidence Study in Sweden (DISS) Diabetologia (2003) 46: 173-181.)

A more precise distinction requires confirmation in the laboratory either by an antibody test for most type 1 diabetes or by a fasting blood C-peptide or insulin level for type 2 and occasionally by more discriminating tests.

It is important to emphasise though that it is the control of blood sugar that matters much more than the exact diagnostic label so that your daughter will not have been harmed by the delay in diagnosis. It seems that she has type�1A (autoimmune) diabetes and will require some form of supplemental insulin until advances in transplanting surrogate insulin producing cells and in graft tolerance make a real cure possible.