Nearly three years ago, my five year old son was diagnosed with type�1 diabetes after spending seven weeks in the hospital from complications resulting from an E. coli infection, and he is considered unusual because his pancreas continues to make a limited amount of insulin and he has never shown signs of the antibodies which attack the insulin making cells. His A1c is always in the high normal range and yet he only takes six units of insulin a day (3N and 3U) in one morning shot.

The doctors feel that my son’s s diabetes is the direct result of damage to the pancreas by complications resulting from the infection since we have no family history of diabetes. Since he does not have the antibodies which destroy the cells which make insulin, does make him a good candidate for islet replacement therapy? If so, how do I go about finding a doctor who will do this or evaluate his potential for this experimental treatment?

Nobody will experiment on a young child with islet cell transplantation until we know the benefits and risks with adults. Just because he does not have obvious antibodies does not mean that he does not have type�1A (autoimmune) diabetes. It is just that he does not have antibodies. Antibodies are not present in every patient. It could be the case that this bad infection caused the diabetes, but without a tissue diagnosis, this is just speculation at the moment.

New research is looking for ways to get transplantation to work, however, with excellent results reported this year not only from the Edmonton group’s ongoing work but also from Dr Faustman’s work in Boston. Both were reported at the recent American Diabetes Association meetings in Philadelphia in June 2001.

As far as high normal hemoglobin A1c levels, you should do some pre and postprandial blood glucose checking and also some overnight checking. Higher A1c level indicate that there is usually some undetected period of time when blood glucose levels are higher than you expect. If you are only or mostly checking before meals and at bedtime, it is likely that you are missing some or all of these. Go be a better detective and it is probably that you will answer this question. Talk it over with your son’s diabetes team, and they can help you interpret these data.

SB