My son (11 years old) was diagnosed as diabetes Type 1 a month ago. He had 800 mg/dL sugar when we went to hospital. He had all the symptoms like excessive thirst, excessive urination, excessive hunger weight loss, fatigue, high blood sugar level, and sugar and ketones in the urine.

After the tests, the doctors started insulin treatment. They started with 40 units per day and controlling the diet and blood sugar level. They reduced it nearly zero at the end of the second week and finally to zero at the end of third week. I thought the honeymoon started at the beginning of week 4. During the 4 week’s time, his average blood sugar level was 110 mg/dL. The maximum level we had reach was 182 mg/dL during this period. And one interesting point was, after playing basketball for 15 minutes, his blood sugar level dropped from 182 to 82 mg/dL. This was the same weather he got insulin or during honeymoon period.

By the tests, the doctors told us that Coxsackie B virus didn’t trigger diabetes but they found mumps marker. And islet cell antibody was negative. The doctors told us that 80-85% of diabetes have this result positive but for some diabetes this can be negative.

Since I am an electronic engineer and understand mathematics, I am always checking the results of the tests. When he was diagnosed, his HbA1c test result was 14% meaning an average of 360 mg/dL sugar level. And yesterday it was 11.52% meaning an average 285 mg/dL. Since blood red cells last about 90 days, this means that, my son’s average blood sugar level several months ago was approximately 335 mg/dL. If this is so, we had to see the symptoms much earlier. And his disease started much earlier. Since the blood sugar average level several months ago was 335 mg/dL, this means pancreas couldn’t produce insulin or a very low level. But during that time he didn’t change his calorie intake.

With those high blood sugars, I don’t think that there can be any doubt whatever that your son does have diabetes mellitus. However in view of the negative Islet Cell Antibody test I think it probable that he has what is now called Type�1B diabetes. Unlike Type�1 diabetes which is an autoimmune disorder, it is still not clear what the basic cause is although some are linked to a chromosomal abnormality. The Type 1B is rather uncommon in Caucasian children; but in North America over half the new onset cases seen in Hispanic or African American children belong to this group. What is important though is that although Type 1B diabetes presents with an acute need for insulin a significant number of them can, after a few weeks be managed with diet, exercise and sometimes oral hypoglycemics and without insulin.

In the meantime you should try to adjust insulin dose, food intake and exercise so that blood sugars fasting or before meals are in the 80 to 180 mg/dl range (4.5 to 10 mmol). For the time being the HbA1c test looks much too high: it should be within 2% of the upper limit of normal for the method employed and although it has been suggested you should not extrapolate an occasional A1c test into blood sugar terms to avoid building a profile of blood sugars at various times in the day as well as occasionally in the middle of the night. I realise that you may be having trouble arranging home blood glucose monitoring; but if you can you should always do a before breakfast blood sugar and then other blood sugars before meals, after vigorous exercise, at bedtime, and occasionally in the middle of the night. You will perhaps only be able to manage two or three blood sugars a day and maybe not even that; but if you can try, as I have said, to get an idea of what they are around the clock. Vigorous exercise, as you have seen, will reduce blood sugars usually within an hour or so; but sometimes after a longer interval. I don’t think viral infections had anything to do with your son’s diabetes.

Finally you might be helped by various Internet sites such as Children with Diabetes, which you already know about and by downloading Peter Chase’s Understanding Insulin-Dependent Diabetes from www.uchsc.edu/misc/diabetes/UI DDM.html.

Finally, the management of Type 1B diabetes is the same as for Type 1A.

DOB