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November 18, 2002

Diagnosis and Symptoms

Question from Charleston, West Virginia, USA:

My 10 year old daughter was diagnosed with type 1 diabetes about four months ago, and at her latest check-up, she had an A1c of 8% up from 6.1% three months ago), an islet cell antibody titer of 11.8, and a C-peptide of 2.5. The pediatric endocrinologist told us there is a new "type" called type 1.5, and that her pancreas is still producing insulin. She is taking twice daily injections, and her blood sugars are still ranging about 150-170 mg/dl [8.3-9.4 mmol/L], with some over 300 mg/dl [16.7 mmol/L]. Can you provide me with any information on type 1.5 diabetes? Would oral medication help? My daughter is on so little insulin that a pump right now is not practical.

Answer:

I don’t think you should worry about this. As we learn more about the genetics and causes of diabetes, we will inevitably begin to subcategorise our patients. In many circumstances, this has little or no implication for how they should be treated now. Essentially, your daughter is likely to still be in the honeymoon phase (a very variable phenomenon) of type 1, and she is doing pretty well. a hemoglobin A1c of 8% is not bad, but it’s not normal either.

To be specific, there is nothing in what you say that makes me feel that oral hypoglycemic agents therapy would add any benefit, but you should discuss this with your daughter’s team. Most importantly, don’t even think about stopping insulin even if the doses are very small.

KJR