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November 19, 2001

Diagnosis and Symptoms, Research: Causes and Prevention

Question from Madison, Wisconsin, USA:

I am 31 years old, have a family history of diabetes, and was diagnosed with "evolving type 1" diabetes about a month ago. At the time of diagnosis, my blood glucose was 486 mg/dl [27 mmol/L]. I had glucose and ketones in my urine and my hemoglobin A1c was 8.6%. Other lab tests showed a normal C-peptide level, positive GAD65 antibodies, and an elevated urine albumin level. I'm still trying to make sense of all of this. Is there any way to stop the destruction of my beta cells while I still have some of them?

Answer:

Nowadays, your history would be considered as typical of Late-onset Autoimmune Diabetes of Adulthood (LADA). Indeed, it seems possible that this was the diagnosis in the other family members. A very complete and easily understandable review of this disorder published in Diabetes Care (24:1460-1467, 2001) is Autoimmune Diabetes Not Requiring Insulin at Diagnosis (Latent Autoimmune Diabetes of the Adult) which you can probably locate at your local library. These is an abstract at the American Diabetes Association website, and you might even consider purchase of the whole review for $8.00.

There has been very little research on how to prolong the life of the still functioning beta cells in this condition except by inference from studies in type�1A in children. There is some rather equivocal evidence that nicotinamide is effective, and you should discuss this with your doctor. Other approaches such as vaccination with Diapep 277, the 9-23 B chain peptide of insulin, and with some of the newer immunomodulatory drugs are still only at the trial stage.

I sense that you are trying to delay or avoid insulin dependence, but might consider temporising with drugs like Glucophage [metformin]. What is important though, is to achieve and maintain good blood glucose control as soon as possible.

DOB