My eight year old son was diagnosed at age five with type 1. We recently went to an endocrinologist who said that he could have a different kind of type 1. She also said he was insulin resistant (from the looks of his fingers) and that his thyroid was full (from the looks of his neck). We do everything by the book (three shots a day four to six sugar checks), and his numbers, most days, range from the 30s to the 300s mg/dl [1.7 to 16.7 mmol/L]. Is there anything here you could help me understand or that you have heard of before? We are waiting for the insulin pump, hoping that will help.

I think that your son almost certainly has what is now called type 1A or autoimmune diabetes. It is, by far, the most common form in Caucasian children in the U.S. In these cases, a moderately enlarged thyroid gland can be seen in about half the subjects, but actual replacement treatment is needed in only about 5%. This finding also rather goes along with the diagnosis of type 1A, and if, by any chance, an antibody test was done at diagnosis and it was positive that would be confirmation. There is another form of type 1 diabetes, type 1B, in which the antibody test is negative, and which is common in African American and Hispanic children, though only seen in 5% of Caucasians. Its importance is that about half the cases can be managed after a few weeks without insulin and sometimes even without oral hypoglycemic pills.

Swelling of the ends of the fingers is common in people with poorly controlled diabetes, but you cannot diagnose any of the many forms of insulin resistance from the appearance of the fingers. In someone who is insulin dependent, you need to demonstrate a normal or high C-peptide level in the serum. It is common in obese children and is found in rarer conditions like Insulin Resistance Type A. There may also be a patchy skin pigmentation called Acanthosis Nigricans.

Whatever the exact diagnosis, the most important thing is to keep blood sugars as near to normal as possible without producing hypoglycemia and an insulin pump should be a help with this.

DOB