My 4-year-old son was diagnosed with type 1 diabetes 7 months ago, after presenting all the usual symptoms. Once we brought him home from the clinic, his insulin needs dropped drastically. Presently, he is receiving 1 unit of R and 6 of NPH once a day, and his blood sugars two hours after eating are almost always in the normal range. I have found that I can be very flexible about his diet and eating schedule without these readings being affected, and his fasting blood sugar is always in the 100-110 range in the morning, no matter what it was when he went to bed. Also, he’s never had serious symptoms of hypoglycemia.

At first I just chalked all this up to the honeymoon phase, but now I’m beginning to hope he might have just have Type 1B, especially since I know this is more common in children of Latin decent, and his father is of Italian/Colombian ancestry. Is it too soon to speculate whether this might be the case? And is the prognosis for future complications better for Type 1B?

In the normal course of events you would certainly have expected your small son’s insulin requirements to have begun to rise again. As you must have found out the definition of Type1B Diabetes is that there is a typical acute insulin dependent onset which after a number of months may well give way to a time when glucose levels can be controlled by oral medication or even by diet and exercise alone.

The basic pathology of these Type1B cases is not yet understood although some of them seem to be associated with chromosomal abnormalities; there is, at all events, no specific positive test that can confirm the diagnosis. What is coming to be understood is that many of these children are hypoinsulinemic not hyperinsulinemic and insulin resistant like Type 2 diabetes so that it is quite possible that one day they will again become insulin dependant.

My suggestion would be to talk to your son’s doctor to see if an antibody test can be done in Panama. A number to call in the US that could provide details is 1-800-425-8361. A positive test would confirm Type 1A (autoimmune) diabetes and the need to continue insulin indefinitely despite the honeymoon period which can last as long as two years. If, on the other hand, the test is negative, or if you can’t get a test, your doctor might consider a gradual reduction of insulin, starting with omitting the Regular and the equally gradual introduction of insulin replacement with an oral drug like metformin [a pill usually used for Type 2 diabetes]. More important than any specific diagnosis is the issue of meticulous control of blood sugar, albeit not to the point of risking significant hypoglycemia.

DOB