January 24, 2003
Research: Causes and Prevention
Question from Annandale, Virginia, USA:
My five year old son was diagnosed with type 1 diabetes at age three, and recently my three year-old daughter seems constantly thirsty. However, I have checked her blood sugar with a meter on these occasions, and her blood sugar is always normal. My son's endocrinologist says that while blood testing is available to determine her risk of developing type 1 diabetes, it could very well yield false positives or false negatives. Moreover, he says that, even if the results were accurate, a recent (NIH) clinical trial showed that nothing can be done to prevent the development of full-blown diabetes in siblings. You seem to be more supportive of getting blood testing. If we did go forward with it, what, in your opinion, would be the benefit of doing so?
Three normal fasting blood sugars are reassuring. Overall, your daughter has only about a 5% risk of succumbing to type 1A (autoimmune) diabetes, assuming that is your son’s diagnosis. You could modify this figure by getting genetic testing for the HLA antigen pattern, and if this showed high susceptibility, then having the routine three antibody tests done for prediabetes.
At the end of the day, though, as your son’s endocrinologist points out, there is no known way of averting insulin dependence, and quite recently two large trials to achieve this, of small doses of injected insulin in the U.S. and of Nicotinamide in Europe have failed to show any benefit. Other trials continue (oral insulin, vitamin D, omega3 fatty acids found in fish oils) and more fundamentally of ways to modify the basic immune response.
[Editor’s comment: Also, see information about the DPT-1 study.