I just started today a MOOC (Massive Open Online Courses) on diabetes offered by the UCSF and am learning quite a bit and reinforcing what I knew before. My son was diagnosed with type 1 less than six months ago. He was in the hospital for diabetic shock for 10 days. They did three tests to determine if he had type 1 or some other type of diabetes. Results: ICA 512 – 5.4; GAD antibodies – <1.0; Anti-insulin - <0.4. Although the results had been there, I had not really strived to understand them. I tried reading online the differences between the tests and I guess I have found all the texts too advanced for me. Can you please explain these results and if there are any implications in short and long term complications? Currently, he is very good at maintaining his blood sugar in check with his latest A1c being 7%. Exercise and good nutrition are key to maintain good numbers for him; whenever there is a deviation in either, his blood sugar numbers go wacky.

The key to type 1 autoimmune diabetes diagnosis is the autoimmune “attack” on the beta cells of the pancreas. Since we cannot see or get tissue from the pancreas very easily, we use blood tests to check for antibodies. These determine indirectly, if the antibody levels are positive, that the autoimmune process is present. The higher the antibody titer levels, the more positive and the more likely that this is autoimmune type 1 diabetes. The problem comes that the tests are not 100% sensitive and specific so that only about 60% or so have positive antibodies. Sometimes they are present before or at diagnosis but do not last very long. Lots of variability makes the exact diagnosis difficult. So, from the number your reported in your question, it looks like weakly positive islet cell antibody and negative for the IA2 and GAD antibodies so this is a weakly positive result. It is best to go back to your diabetes team and ask them specifically since they can interpret the results knowing the assays that are being used. ;p>

As it turns out, antibody testing is more useful for research purposes than for clinical care decisions since the ease or difficulty of controlling the blood glucose levels often becomes rather obvious. There can be some problems if obesity also co-exists, also some overlap of type 1 and type 2 diabetes not just in obesity but also with non-Caucasian populations. Control of glucose over time is frequently helpful to decide whether insulin or other medications can be used for control of the diabetes but based on actual blood sugar results, medications needed to achieve such control, weight and physical exam.

SB