My eight year old daughter was diagnosed about six months ago with a blood sugar of more than 400 mg/dl [mmol/L], but she had no antibodies present. How can my daughter have type�1 diabetes if there are no antibodies?

Whilst by far the most common cause of diabetes in children in North America and Western Europe is due to a disorder of the immune system and is referred to as type�1A (autoimmune) and these cases almost always have positive antibody tests, there are several other forms of diabetes in children in which the antibody test is negative at onset. The most common of these is now referred to as type�1B or idiopathic diabetes. In Caucasian children, only about 5% of new onset case are of this type, but in Hispanic and African American children, the incidence is a little over 50%. Whilst this seems to be a syndrome of insulin deficiency, in its early stages in about half the cases, they may well become insulin independent at least for several years and can be managed with oral hypoglycemic agents or even just with diet and exercise. The underlying cause is not yet fully worked out.

DOB

[Editor’s comment: Of course, there’s always the bug-a-boo of “lab error” — that is, a lab result that doesn’t fit the clinical picture. For example, some older lab assays for antibodies are less reliable than the newer ones. Or the “wrong” antibody may have been measured — sometimes only one or two of the 3 possible antibodies (ICA512, GAD and IAA) are positive, and if the others are measured, they’d be misleadingly negative.

WWQ]