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January 3, 2000

Diagnosis and Symptoms

Question from Lyndhurst, New Jersey, USA:

My 13 year old son was diagnosed with type 1 diabetes a month ago. I know he was tested for antibodies and he did have them. He entered the hospital with a blood sugar level of 350 and no ketones. The doctor told us we caught him at an early stage of diabetes. His insulin requirements did decrease to two injections a day. The morning he only takes 8units of NPH and at bedtime 2 units of NPH. His levels run between 80-130. Is there anyway he can be a borderline diabetic? I realize he must be going through the honeymoon phase, but could he have been misdiagnose? No one in either family has diabetes. What does it mean if you have antibodies? Can only a portion of your pancreas work enough to produce insulin? And is there a test to show how much of your pancreas is still producing insulin?

Answer:

With the high initial blood sugar and the positive antibody test there can be no doubt that your son has Type�1A (autoimmune) diabetes and that he will require insulin for the foreseeable future. The honeymoon phase can be quite variable in its duration; but usually lasts only a few weeks after which his insulin needs will rise to between three and four times what he is getting at the present. The important goal is to help him adjust to the disciplines of meticulous control at a time when this is increasingly possible technically; but at an age that may make the process difficult.

The process of autoimmunity is far from clearly understood. Put simply though in genetically predisposed individuals some environmental trigger induces changes in some of the white blood cells, specifically lymphocytes, that leads them to very slowly over a period of years destroy the insulin producing or beta cells in the pancreas. These cells in turn leak various proteins to which the body makes antibodies. Insulin is one, an enzyme called glutamic acid dehydrogenase (GAD) is another and the third that is commonly measured is called ICA512.

It is possible to measure residual insulin production using a test called the ‘intravenous glucose tolerance test with 1 and 3 minute insulin levels’. It is expensive and cumbersome and not really useful at this stage in making the diagnosis or in influencing clinical treatment.

DOB