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August 6, 2001

Diagnosis and Symptoms

Question from Denver, Colorado, USA:

Judging from your definition of different types of diabetes as well as your responses to some of the questions here, I feel that my 10 year old son from an Asian family has type�1B diabetes.At the time of diagnosis, his pre-meal.blood sugar was 250 mg/dl [13.9 mmol/L], and he had some ketones, but no antibodies. He was on insulin for the first four months, but over the period of time, with weight loss, regular exercise, and good blood glucose control, his endocrinologist said he appeared to have type�2 diabetes and had him off of insulin. For the last three months, he is been doing great without insulin with pre-meal blood glucose levels of 80-110 mg/dl [4.4-6.1 mmol/L] I am still confused as to whether my son has type 1b diabetes in a honeymoon period or he indeed has type 2 diabetes which is improving. How important is it at this point of time to determine what type of diabetes my son has? In either case, will he need insulin again somewhere down the road even if he keeps good metabolic control? By the way, his doctor doesn't seem to differentiate between type�1A and 1b.

Answer:

It is often difficult to tell which type of diabetes a person has. Over time, this usually becomes clear. The most important thing is to control the blood glucose levels based not only upon hemoglobin A1c values but also on pre- and postprandial glucose values. Talk to your son’s diabetes team and they can give you the best individualized advice, of course.

Sometimes, antibodies remain negative. Sometimes, they become positive. Sometimes, positive become negative over time. The tests are not as ideal as we would all like them to be.

SB