My 35 year old friend was recently diagnosed with type 1 diabetes after being hospitalized with DKA. She had visited me in Egypt, and, apparently, her doctors think she may have contracted the virus here. How is the virus transmitted, and what are early symptoms? Should I be tested if I have experienced a period of fatigue and appetite fluctuation without significant change in weight? These “symptoms” are part of normal life for many Westerners living in Africa, so is there anything more specific I can watch out for?

There are a number of ways in which a viral infection may be associated with the clinical onset of type 1 diabetes. By far, the most common is when an infection, of any kind, stresses the insulin producing cells that have already been slowly damaged over several years to the point that additional insulin is required to produce normal blood sugar levels. It is unusual nowadays for this to get to the point of causing diabetic ketoacidosis and coma, but in Cairo it might not have been so readily recognised. Insulin dependence that is finally triggered in this way is not infectious, and you have no cause to be alarmed that you might have ‘caught’ diabetes.

Quite uncommonly, the enteroviruses, especially the Coxsackie group, can release a part of their envelope that is very similar to the normal GAD enzyme which then gets attached to an antigen presenting cell and thus starts the long process that is type 1A (autoimmune) diabetes in genetically predisposed individuals. I don’t think that this could possibly have been the problem in your friend’s case.

Finally, the Japanese recently described a very small number of cases in which there did indeed seem to have been a very rapid viral destruction of the beta cells. In these few cases, the antibody test which is positive in the much more common type 1A or autoimmune diabetes was negative.

I hope your friend gets better soon and will be helped by this site to maintain excellent blood glucose control.

DOB