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February 1, 2007

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Question from Spartanburg, South Carolina, USA:

I am 22 years old and have a strong family history of diabetes. My father has type 1, my aunts and uncles have types 1 and 2, and grandparents have/had type 2, all on both sides of my family. I have had type 1 for three and a half years and use an insulin pump. At the time of diagnosis, my blood sugar was a little over 200, mg/dl [11.1 mmol/L), my A1c was 5.9 and I had positive antibodies. I have had very good control of my diabetes since diagnosis, with A1cs of 4.3 to 5.1 and a C-Peptide of 2.9. I now have been diagnosed with hypothyroidism and still have very good control. I check my blood sugars six to 10 times a day. Is it possible I will continue to have very good control with no problems or will it get worse over time? Will I continue to have insulin production if I keep taking care of myself and doing what my doctor says or will my pancreas eventually stop working? I am very strict with my diabetes care.

Answer:

One of the points of disease management research in type 1 diabetes is how to maintain some insulin secretion. With even partial insulin secretion, you have a better chance of maintaining good glucose control. Currently, the concern is that your ability to produce de novo insulin will wane over time, due to the natural history of the disease. At this time, there is no specific therapy for preserving beta cell function in patients with type 1 diabetes. There are some studies looking at patients with newly diagnosed diabetes and treatments to maintain beta cell function. The best thing you can do is maintain the good control.

JTL