My 14 year old son was diagnosed last year with type 1. He entered the hospital with a 350 mg/dl (19.4 mmol/L) blood sugar and no ketones. He did test positive for antibodies. He had his first 3 month check up with his endocrinologist, and I just received the results. His A1C test results was 5.8 percent. His C-peptide was 1.6 ng/ml (reference range: stated 0.5-2.0 ng/ml). Doesn’t it seem he is making most of his own insulin? He only takes 8 units of NPH before breakfast. Could he have another type of diabetes instead of type 1? He has lost six-and-one-half pounds in the last three months. I know he is going through a honeymoon period, but can he be controlled by medication instead of injections?

Your son’s story is a familiar one. The finding of a positive antibody test means that he has what is now called autoimmune or Type�1A diabetes. The disorder of the immune system that ultimately destroys the insulin producing cells in the pancreas may well have started in the first year of his life. This process can be extremely variable, sometimes leading to overt insulin dependant diabetes in infancy, and, sometimes taking many decades. The point at which prediabetes needs additional insulin and becomes frank clinical diabetes is usually relatively sudden, triggered by some exogenous stress like an infection and followed, after a short period of insulin supplementation, by the so-called honeymoon period that usually lasts a few weeks. However, it may sometimes extend to months and very occasionally over a year.

In past years, it was fairly common to take advantage of the honeymoon period and discontinue insulin. More recently, however, it is felt that it is a disadvantage to do this and give the impression that the diabetes was something transitory. As matters stand at the moment, he is likely to need insulin, by some means or other, for the rest of his life. Islet cell transplants, inhaled insulin, and insulin bound to a special intestinal transport protein are good possibilities to, one day, relieve the tyranny of injections. In addiition, blood sugar measurement is every year becoming less of a trial. I am sure that his doctor will confirm that now is a time to get used to the disciplines needed for excellent control of blood sugars and to recognise that insulin requirements will shortly increase and C-peptide levels decrease.

One additional point is the continued weight loss. Children often lose a significant amount of weight in the weeks prior to the development of clinical diabetes because there is insufficient insulin to promote normal body protein synthesis. Usually, however, there is an abrupt reversal of this as soon as insulin is given by injection. In these circumstances, I wonder if you should talk to your son’s endocrinologist about getting a test for anti-transglutaminase antibodies done. This is an assay for the celiac syndrome, an immune disorder causing wheat sensitivity that is linked to diabetes in about 10% of cases.

DOB