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June 4, 2008

Diagnosis and Symptoms

Question from Hartford, Vermont, USA:

I am 30 and have had type 1 since I was 14. When she was three and a half-years-old, my now eight-year-old daughter had blood sugars from 150 mg/dl [8.3 mmol/L] to 198 mg/dl [11.0 mmol/L]. Once, she was 204 mg/dl [11.4 mmol/L]. So, she was diagnosed with pre-diabetes. Her A1cs have been 6.7 and 6.6. We have had GAD-65 and MIAA levels drawn along with the anti-islet cell antibodies. First, only the MIAA came back positive. They repeated the tests again three or four months later and, now, she has both the GAD-65 and the MIAA antibodies. She has, from time to time, frequent urination and frequent drinking, Is there anything else I can do for her? Is she going to end up with type 1 diabetes? She also has a complete IgA deficiency, no IgA at all. We had the special spin down on that, also, and we were told if she ever needed a blood transfusion she would not be able to have it because she could have a anaphylactic reaction. What does all of this mean for her? I know it’s not normal and we are trying to keep her on a healthy eating plan to prolong the onset of diabetes if that’s what is going on here.


From: DTeam Staff

With multiple antibody levels positive for pancreatic antibodies, this does not bode well. Her risks are high. You should be in close contact with a pediatric diabetes team who can monitor her with you. Please pay close attention, as you sound like you already are, for changes in urination, weight, thirst, especially during periods of rapid growth or any viral illness since these are the likely times that her pancreas could finally stop making insulin. I would assume that the physicians ordering the antibody tests have already talked to you about this. There are several experimental trials looking at ways to stop the slow autoimmune attack but, they are experimental. One interesting study has suggested that strict avoidance of all wheat and gluten products, just as if she had celiac disease, sometimes helps to stave off the ongoing autoimmune antibody attack.

The IgA deficiency also makes one wonder about other autoimmune disorders, i.e., Hashimoto’s thyroiditis, Addison’s disease/adrenalitis, pernicious anemia and folic acid/vitamin B12 disorders as well as celiac disease. Here, too, consultation with a pediatric diabetologist may be very important.