Justin Delgado is husband to Kacie Doyle-Delgado, diagnosed at age 11. After more than a decade together, he considers himself to be an expert carb counter and Dexcom inserter. He graduated with his Master of Science in Finance from the University of Utah in 2013 and has been working in commercial banking since then. He attended his first Friends for Life conference in 2015 and is looking forward to volunteering with the teens.
March 23, 2001
Diagnosis and Symptoms
Question from Yorktown, New York, USA:
My eight year old son was diagnosed with type 1 diabetes a couple of months ago. His fasting blood sugar when he was hospitalized was 198 mg/dl [11mmol/L], and he had a 2+ level of ketones in his urine. Our endocrinologist said he was definitely type 1 because he had ketones and low insulin (3.3). However, when his lab results came out a month later, we realized his antibodies (including insulin antibodies, islet cell antibodies, and GAD antibodies) were all negative, and his insulin level on admission was again 3.3 and C-peptide, 0.9. My sister, a pediatrician, suggested to get a second opinion on the test results. So we brought these to another endocrinologist, who suspected that my son might be type 2 because of the negative antibodies and the fact that he was a little overweight -- he had a fatty liver. He is now taking insulin (NPH and Regular) twice a day and doing okay. What is your opinion about the lab results? Is it important to find out whether my son is either type 1 or 2? Is there anything we can do at this stage to find that out? If it's type 2, do we need different treatment for my son?
We all wish that there was a clear test to determine if a child has type�1 or type�2 diabetes. The final diagnosis is based on multiple factors including a detailed history and physical examination in addition to the lab testing that you have provided. Negative antibody tests do not rule out type 1 diabetes. These tests are more helpful in making the diagnosis of type 1 diabetes only when they are positive. I agree that is important to determine if your child has type 1 or 2 diabetes, but this must be done by a pediatrician or pediatric endocrinologist with experience in differentiating the two diagnoses in difficult cases such as with your son.
Additional comments from Dr. Donough O’Brien:
You should also perhaps ask about type 1B diabetes, where after a time blood sugars may be managed without insulin and with oral hypoglycemics or just diet and exercise.
[Editor’s comment: The insulin and C-peptide levels you cite are low if they were done at the time as the blood sugar of 198 mg/dl [11.mmol/L]. However, your son may have type�1B in which antibody tests are negative, and many children become insulin independent after a while. He might also have type 2 or Maturity Onset Diabetes of the Young. It really makes little difference as long as he is doing well.