May 23, 2002
Diagnosis and Symptoms
Question from Savannah, Georgia, USA:
My six year old son was diagnosed with type 1 diabetes last year, and he took tiny amounts of insulin for 10 months, but his blood sugars have been so good that we stopped the insulin. His A1c has been 5.3% three times this year, and he is not on a diet (enjoying sugar again) and still has sugars of only 130 mg/dl [7.2 mmol/L] or less. Now his doctor is changing diagnosis to honeymooning, islet cell disorder or pancreatic problem. Help! Could my son be in a honeymoon for more than a year? Am I getting my hopes up that he has been misdiagnosed?
Without more in the way of clinical details, it really isn’t easy to answer your question very precisely. The first possibility is that he does indeed have type 1A (autoimmune) diabetes and that some rather mild intercurrent infection triggered a visit to the doctor and the incidental discovery of a high blood sugar. It would be unusual, but not unrecorded, for him to have had this extended honeymoon period.
What will establish this diagnosis is an antibody test. However, under these circumstances, I would suggest looking for the standard three antibodies (anti-insulin, anti-GAD, and ICA512.
Also (and especially if he is of Hispanic or African American descent) and was clearly insulin dependent at the onset, he might have what is called type 1B diabetes which is antibody negative. If on the other hand, the diagnosis was based on a single blood sugar or a non-fasting one, he may not have diabetes at all — and the unusually low hemoglobin A1c rather favours that. Small children quite often show abnormally high blood sugars solely on the basis of stress. If he is overweight and disinclined for exercise, he might have type 2 diabetes which is on the rise in childhood. Finally, there are a number of other much rarer possibilities.
You need to talk these alternatives over with his doctor, but I hope these comments help.