My 14-year-old son was diagnosed with type 1 diabetes just one week ago. The development was sudden. His C-Peptide measured 0.55 pmol/ml (normal is 0.36-1.7 pmol/ml) and GAD antibodies were 0.29 units/ml (normal 1 unit per ml). No antibodies for beta cells are found. His sugar levels are now between 6.0 mmol/L [108 mg/dl] and 7.0 mmol/L [126 mg/dl]. He is taking short-acting insulin and 20 units of Lantus in night.

Based on his test results, it is known that his diabetes is not autoimmune. Are there any types of treatment other than giving insulin shots before every meal. What is the latest method of insulin intake that is commercially available?

My six-year-old daughter was tested for diabetes. Her glucose tolerance test was negative (all okay). Her insulin level was normal, her GAD antibodies were 0.63 units per ml (normal 1 unit per ml). I want to know the chances of her being diabetic in future, what tests should be done to know the possibility, and what precautions we should take for her.

I am sorry to say that it is likely that your teenage son really does have type 1 autoimmune diabetes even with negative antibodies. Since antibodies are only positive about 60 to 80% of the time, this is not so uncommon. Whether or not he has any residual beta cell production of insulin is also difficult to assess particularly with relatively new onset diabetes. His clinical course and the status of how easy or difficult it will be to deliver insulin to him and control daily blood glucose levels over the coming months will better define his diabetes than any of the tests currently available. If there were also positive antibody tests for thyroid (Hashimoto’s) and/or celiac disease (transglutaminase antibodies), this would also lend towards typical type 1 autoimmune diabetes.

As for treatment of a 14 year old with new onset diabetes, aggressive insulin administration aimed at bringing down the glucose levels towards the normal range and providing flexibility with meal time insulin bolus needs, as well as basal insulin needs, usually is the norm in most diabetes specialty centers. We prefer bedtime and morning Lantus with meal time human analogs such as Humalog or NovoLog, but there are many different approaches. The key is to get and keep the A1c levels safely below 7% without excessive episodes of hypoglycemia. So, it sounds like you are on the right track and need to continue to work closely with your diabetes team to reach these goals and use frequent blood glucose monitoring as your standard.

Lastly, risks for other children when one is diagnosed with type 1 diabetes as a teenager are in the range of 2 to 5%. It is usually only with research protocols that siblings being tested because of the expense and the vagaries of the test results. All such interventions for your son with diabetes and siblings are still experimental.

SB