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December 13, 2007

Diagnosis and Symptoms

Question from Freehold, New Jersey, USA:

I took my nine-year-old son, who was diagnosed with type 1 in April 2006, to a new endocrinologist at a major teaching hospital in our area. The new doctor was concerned that all three of my son's antibody tests came back negative at diagnosis. He also was surprised that he had no ketoacidosis with a blood glucose of 660 mg/dl [36.7 mmol/L] at diagnosis. My son had laboratory work recently by his previous doctor for celiac, thyroid, etc., which was all normal. His old doctor never repeated the antibody tests. My son is on a pump has an A1c of 7.2 and receives about 10 units of NovoLog per day. The new doctor gave me a prescription for new antibody blood work. He mentioned other types of diabetes. I am confused! What is he looking for? Could my son have been damaged for the past year? Please explain the possibilities.


It is not unusual to have negative antibodies and most pediatric diabetologists do not actually test for them except as part of a research protocol, since it does not change therapy. This is different in extremely young children, i.e., less than three years old where a type of diabetes called monogenic diabetes can sometimes be confused with autoimmune type 1 diabetes. So, while it will not hurt to have more antibody levels tested, they likely will not change much of anything whether they are positive or negative. I would encourage you to ask the new team what they are looking for and why they needed this type of information so that you can better understand their reasoning. We usually recommend testing for thyroid functions and thyroid antibodies annually for the first few years and then less later on; we usually recommend testing for celiac antibodies also on the same schedule. We check lipids about each year and as you get towards the pubertal years, then more specific kidney functions, microalbumin, etc.


[Editor’s comment: Please see some of our many previous questions on the Diagnosis and Symptoms of diabetes to learn more about antibody testing.