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July 12, 2001

Diagnosis and Symptoms

Question from Lambertville, Michigan, USA:

My 12 year old son has type 1 diabetes, and two years ago, my eight year old son was identified as being high risk for developing diabetes through the DPT-1. Occasionally, he seems to drink a lot, is moody, and often is tired. He has had no weight loss, yet no gain for a while. We check his blood sugars occasionally when he shows these symptoms, and while most readings are between 90-100 mg/dl [5- 5.6 mmol/L], he has had two high readings (219 mg/dl [12.2 mmol/L] and 152 mg/dl [8.4 mmol/L], two hours after a meal). At what point should I consider a diagnosis of diabetes? Do we wait until he has more overt symptoms?

Answer:

If the initial islet cell antibody screening test through the DPT-1 trial was positive then, since his older brother has type�1A (autoimmune) diabetes, he too probably has it even if his glucose tolerance is almost normal. At this stage it is often called ‘prediabetes’, so the important question is at what point is he going to develop insulin dependent diabetes?

You do not say what the results of the further DPT-1 testing were, that is to say of the intravenous glucose tolerance test, the HLA typing, the repeat ICA test, the GAD antibody test, and the anti-insulin antibody test. If, after these, he qualifies for the oral insulin part of DPT-1, I think that you ought to consider participating in the study. If however, further testing was declined and he is just positive in a single ICA test and blood sugars are for the most part normal, there is obviously a case for delaying insulin treatment. There are some intermediate possibilities that you might discuss with the diabetes doctor.

One would be to give Nicotinamide: The results of ENDIT, the Europaean trial, are not yet available, but in a group of New Zealand school children, it delayed the need for insulin in about 60% for a number of years. Quite recently a group in Sweden have used the drug diazoxide to ‘rest’ the islet cells to achieve the same effect. A single small daily injection of the new insulin Lantus (insulin glargine) would also have a similar effect. The final choice might be just to monitor blood sugars more carefully until they are consistently abnormal, but this incurs the risk that an unexpected infection might precipitate DKA [diabetic ketoacidosis].

Irrespective of what you decide in the light of additional information, it might also make sense at this stage to test for two other commonly associated conditions, that is to say hypothyroidism with a TSH test and celiac syndrome with an anti-transglutaminase test.

DOB
Additional comments from Lois Schmidt Finney, diabetes dietitian:

If this boy is at high risk of developing diabetes, he is not eligible for the moderate risk part of the DPT-1. An OGTT can be done as part of the DPT-1 for those at high risk and in about 6 month, there will be further studies of prevention of type 1 under the TrialNet study.

LSF

[Editor’s comment: It’s not clear whether your son(s) is/are under the care of a pediatric diabetes team. If not, ask for a referral to help decide what to do now.

WWQ]