My three year old niece was diagnosed with type�1 diabetes after she was hospitalized for 40 days with E-coli [bacterial] complications. After my sister insisted on a second opinion, it was determined through an antibody test that she is not type 1. Even though her C-peptide levels are low, her hemoglobin A1c is good. Can she be put on pills? She has been having trouble with being low. In fact if she gets below 90 mg/dl [5 mmol/L], she complains of hunger, back aches and is grumpy. What should their next step or tests be?

With an acute onset of insulin dependent diabetes, but with a negative antibody test and a low C-peptide test, the diagnosis would now be called type�1B diabetes. This is quite rare in Caucasian children, but common in Hispanic and African American new onset cases. The underlying pathology is not yet well understood though some are linked to chromosomal changes. Unlike type�2 diabetes in children they are basically insulin deficient, not insulin resistant. Many of them though can be taken off insulin after some weeks and managed on oral hypoglycemic agents and even occasionally with diet and exercise. In the long term, it seems probable that most will require insulin supplementation. I don’t think any further tests are needed, but her mother should talk all this over with the doctor and perhaps just try an oral hypoglycemic like Glucophage [metformin] to see if the present excellent control is maintained with less risk of hypoglycemia.

DOB