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June 3, 2009

Diagnosis and Symptoms

Question from Bordentown, New Jersey, USA:

I am 20, have had type 1 for three and a half years and just transitioned from a pediatric to an adult endocrinologist. I now go to the Naomi Berrie Diabetes Center in Manhattan. My A1c has always been in the 5.5 to 6.1 range and only got to 6.1 one time. Usually, it's 5.6 to 5.8. I am reading that there are some people who continue to produce small amounts of insulin throughout their lives and are therefore able to control their diabetes better. My new endocrinologist seemed to say this, too, I think. Is this true and is there such a thing as a "mild form" of type 1 diabetes? I use an insulin pump. Is my excellent control to date attributed to my pump or to the fact that I may still be producing some insulin?

Answer:

The only way to know if you are producing insulin is to measure the production with a test called C-Peptide. Ask them at the Berrie Center and they can decide if it is worth spending a lot of money to answer your question. The older age of onset, the more likely there is a prolonged honeymoon compared to children and younger adolescents. If your control is excellent and A1c levels also excellent, then keep doing what you are doing with your pump since this also tends to prolong beta cell function and keep things easier to control overall. There is even an older adult form of diabetes now called LADA – latent autoimmune diabetes of adults – that is antibody positive but significantly different from other, usually type 2 diabetes, in adults. There is much longer “honeymooning” than children and teens, but an indication with positive antibodies that insulin will be needed sooner rather than later. Most likely, you have the older teen/young adult type 1 autoimmune diabetes with some partial insulin production helping you out. That’s good news.

SB