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July 21, 2020

Diagnosis and Symptoms

Question from Corunna, Michigan, USA:

My newly diagnosed daughter had a bronchitis-type illness around December 2019 and was treated with albuterol, prednisone, and antibiotics. She was diagnosed in January 2020 and I was told the virus was likely a trigger. It has been overwhelming and, now that we are settled in and things are going well, I am seeking input on some lingering questions I have. I would greatly appreciate your input.

1. Could prednisone have caused her immune system to attack her pancreas? I know prednisone can affect sugars. She was on it for ten days due to bronchitis-wheezing in early December.

2. We live near farm fields but try to avoid being out when fields are sprayed, etc. Could something like this have caused a shift in her autoimmune system? Or, what about carpet cleaners I use periodically in my home? Or, Round Up or the bug spray we used once for ants?

3. Was she bound to get this all along at some point in life? How would one know how long she has had the antibodies; was it since birth?


From: Dr. Stuart Brink

Any viral or bacterial illness can precipitate type 1 diabetes in someone otherwise genetically susceptible. But, this is a rather nonspecific response. There are lots of research studies on this but, so far, still nonspecific. There have been some genetic studies as well but nothing that merits anything more than more ongoing research so far.

Prednisone and other corticosteroid medications all are similar and raise the blood sugar levels as a secondary effect. So, if someone is prone to develop diabetes, this would make higher sugar levels than just the virus. Prednisone doesn’t seem to do any direct damage to the pancreas, however, unless pancreatic beta cells are “pre-programmed” to fail genetically.

Many chemicals have also been implicated, but mostly with type 2 insulin-resistant diabetes and not so much type 1. Type 1 diabetes is often present with positive blood antibodies and you should inquire as to whether or not your diabetes team actually tested for these. Not everyone is positive but, if positive for one of the 4 commonly tested, this would indicate the genetic predisposition and then the bronchitis was the precipitating event. The only way to answer questions about how long someone has antibodies is to have them part of a research study. When this is done with brothers or sisters (identified by the “index case” already diagnosed with type 1 diabetes) , we know that not everyone develops antibodies before actual diagnosis and the time when they develop is also pretty variable. So positive antibodies would raise awareness (and worry, of course) but also allow diagnosis when blood sugar levels rise (with testing), more awareness during usual illnesses to which we are all exposed and therefore keep people out of hospital, seen earlier and less sick, less dehydrated, etc. at the time of diagnosis. In theory, we might be able to develop something to chemically protect such positive antibody individuals, but this, too, is still mostly experimental.