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January 26, 2003

Diagnosis and Symptoms

Question from Sydney, Australia:

My eight year old daughter was diagnosed with type 1 diabetes 18 months ago. Six months later, we tested my son for antibodies, and his results came back worse than my daughter's. Her insulin antibody level was less than 20 is while his were 1200, her islet cell antibody level was 93 while his was 125, and she had a GAD antibody level of 0.16 while his was 0.77. My daughter's endocrinologist was very surprised my son didn't have symptoms, wanted me to test him at home about two hours after meals, and bring him in if his levels were over 11 mmol/L [198 mg/dl] -- which they have not been. The endocrinologist has said he is likely to develop type 1 diabetes in the next two to five years but also says there is no real proof. Can you give me any more information as to why my child who has not developed diabetes had worse antibody results than my child who did? The endocrinologist couldn't really answer the question.

Answer:

The relationship between antibody levels in the blood and the degree of destruction of islet tissue is not clearly defined because, amongst other reasons, it is difficult to measure total islet cell mass. What is known though is that antibodies do not of themselves destroy insulin producing tissue.

It is has also been shown first that there is a direct relationship between the chances of developing insulin dependent diabetes and the number of positive antibody tests i.e. anti-GAD, anti-insulin, and ICA 512. Antibodies do eventually disappear in type 1A (autoimmune) diabetes after several years of treatment; but also in the prediabetic phase without ever reaching the stage of insulin dependence.

I think that what happened in your family is that your daughter had lost almost all of his insulin producing cells by the time she was diagnosed and that the stimulus to antibody formation was already on the wane. In your son’s case however, there is enough islet tissue remaining to keep blood glucose levels normal, but the rate of autoimmune destruction is nearer the peak.

There have been a number of studies on children at this stage to see if the need for insulin can be averted and so far they have been ineffective including two major programs, one of small doses of injected insulin in the U.S. and another of nicotinamide in Europe. Others continue including using small doses of vitamin D and the so called omega3 fatty acids in fish oils and now attempts to moderate the fundamentals of the immune system responses.

DOB