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January 10, 2001

Diagnosis and Symptoms

Question from Pekin, Illinois, USA:

My five year old son was diagnosed with diabetes about four months ago when his blood sugar was over 800 mg/dl [44.4 mmol/L]. No other tests were done. His body is still making some insulin. In fact, I have to continuously give extra carbohydrates to keep the blood sugars up. Is it possible something else could have raised his blood sugar and he really doesn't need any insulin?

Answer:

I am sure that the diagnosis of insulin dependent diabetes was correct. Nowadays however, two forms of this have come to be recognised. The first is type 1A or autoimmune which is due to a long-standing disorder of the immune system. Insulin, even in quite small doses, will be needed for the foreseeable future and there is quite often an association with other autoimmune problems especially hypothyroidism. The type 1B or idiopathic form comprises only about 5% of new onset cases in Caucasian families, but a little over 50% in Hispanic or African American children. Distinguishing between the two forms is primarily important because about 50% of the Type 1B subjects can be controlled after a number of weeks either with oral agents
At this stage, it is sometimes hard to tell between a child with the type 1A form in what is called the honeymoon period during which insulin requirements can, for a time, be minimal, and type 1B in which the need for insulin has begun to diminish. The test that normally distinguishes between the two forms is called an antibody test, and a positive result indicates type 1A. Nowadays, this test is often done at the time of diagnosis, and although it ultimately becomes negative, it could still be helpful in your son’s case because he is still making some insulin of his own. Whatever the result of the test, the objective must be to keep blood sugars as near to normal as possible without producing hypoglycemia.

One last point is that you did not say whether your son was still on insulin. If he is, you need to talk to your diabetes team about whether to deal with low blood sugars by lowering the insulin dose rather than by adding carbohydrate.

DOB