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July 5, 2001

Research: Cure

Question from Ocean, New Jersey, USA:

My eleven year old son was diagnosed with type 1 diabetes 11 months ago. He had the classic symptoms of extreme thirst and frequent urination, but only intermittently. He has always had an exaggerated roll of fat around his middle, but he isn't really heavy anywhere else. He's very physically active, so the fat has nothing to do with lack of exercise. At diagnosis, he presented with a non-fasting blood glucose of 415 mg/dl [23.1 mmol/L], a C-peptide value of 0.7, and he tested negative for islet cell antibodies. He is on very low doses of insulin (10 units of NPH and 5 units of Humalog daily), and we frequently lower the dose when heavy activity is expected. As I think back, he has had some weird issues with milk and dairy products since he was very young and was on soy formula until he was almost two and a half years old. It was after we moved him to regular dairy that he began developing that roll of fat around his middle. I have read that many people with diabetes test positive for milk and dairy intolerance. Is it possible that my son's diabetes has been actually a reaction to some sort of allergy? If his diabetes was triggered by an allergy, could this be making him insulin resistant? If we eliminate the offending food from his diet could we possibly get him off of insulin injections?

Answer:

Early exposure to certain cow’s milk proteins has been thought to be an environmental factor in the genesis of autoimmunity in type 1A (autoimmune) diabetes. Excluding dairy products from the diet would not lead to insulin independence at this stage.

In any case, given the acute onset, the negative islet cell antibody test, and the now rather small insulin requirements, I think that your son could well have what is now called type 1B idiopathic diabetes. The underlying pathology is not well understood yet though some may be due to another form of autoimmunity and some linked to chromosomal changes. It is uncommon in Caucasian families, but comprises just over 50% of new onset cases in Hispanic and African American children. Perhaps most importantly, in about half, insulin requirements slowly diminish, and these children can control blood sugars with oral medication, sometimes with just diet and exercise. Long term though, it is likely that they will again become insulin dependent.

DOB