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November 7, 2003

Diagnosis and Symptoms

Question from Washington, USA:

Approximately weeks before returning home from the Middle East, I had a 103o F fever and stomach problems, and right around that time, I started having classic DKA symptoms. When I made it to the hospital, I was diagnosed with type 1 diabetes. I was on a Humalog with Lantus regimen for three weeks and haven't needed anything since then. My glucose levels returned to normal, and it has been five weeks since I needed insulin injections. Does this sound like a transient case of diabetes or just rapid onset of the honeymoon?

Answer:

I think that there are a number of possible explanations for your story; but I am afraid that a “transient case” is not one of them. The most likely explanation is that you do indeed have some form of type 1 diabetes and that some stress such as an intercurrent infection temporarily precipitated clinical diabetes. If this is so, then the need for insulin will recur probably within the next year.

To evaluate this possibility, you need to ask your doctor about getting an antibody test. It is important though to make sure that the test is done by a laboratory that reports the result, not as a number, but as a clear positive (above 99% of normal) and includes all three conventional antibodies [antiGAD, IAA (antiinsulin), and islet cell antibodies (ICA 512)]. There are other possibilities such as type 1B (idiopathic) diabetes, type 2 diabetes and even MODY3 (Maturity Onset Diabetes Type 3), but these can be sorted out after you get the result of the antibody tests.

DOB
Additional comments from Dr. Stuart Brink:

From the brief information you provided, it’s impossible to know, and this is a bit fast for a classical honeymoon but possible. The older you are, the more likely you would be to have some insulin reserves remaining. The more elevated the blood glucose and the more ketones present (the greater the DKA [diabetic ketoacidosis]) at diagnosis, the less likely that this would be a honeymoon period. It isn’t so typical for diabetes to begin in the fashion you described but certainly any illness could “tip” you into a state of more severe insulin deficiency at that moment.

You should have islet cell and GAD 65 antibodies checked since if they are positive it is more likely that you will need insulin once again; if the antibody tests are negative, it wouldn’t be very helpful since about 20-40% could be antibody negative and still have classical autoimmune diabetes.

SB