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March 4, 2003

Diagnosis and Symptoms

Question from a practical nurse in Mt. Hermon, Louisiana, USA:

My daughter is having hyperglycemia, was started on insulin by phone, and I feel like I am hanging out there on a weak limb.The first time she had this problem she was on prednisone for her asthma. The second time she had been sick and in the hospital but not on steroids. Now I don't know why it's up. She had the classic symptoms of thirst and frequent urination. Since she was negative for antibodies for type 1 diabetes two months ago, they think it may be stress-induced. My daughter has had a lot of other major health problems in her short life. Do you think this has contributed to this problem? Would this be considered to have type 2 diabetes? Do you think it will go away again? Could she possibly go on oral hypoglycemic agents in the future if she continues to have problems? Anything you can tell me would be appreciated.

Answer:

I think that there are some points that you need to discuss with your daughter’s doctor. The first concerns the antibody test. If this was really negative for all three of the usually assayed antibodies, then she does not have type�1A (autoimmune) diabetes, but might have type�1B diabetes with a good prospect that it can at some stage be managed without insulin. She might also have one of the many forms of insulin resistant diabetes which includes type�2, an increasing problem in childhood. A serum C-peptide test would be useful to distinguish the latter.

At the end of the day however, what really matters is not the precise diagnosis; but being able to control blood sugars and hemoglobin A1c levels by the simplest means.

DOB