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June 16, 1999

Research: Causes and Prevention

Question from Grand Island, Nebraska, USA:

My five year old son was diagnosed with Type 1 diabetes two months before his second birthday. Type 1 diabetes does not run in my family, nor his father’s. My son had a serious case of croup about 6-8 months before he was diagnosed with diabetes. I heard that it is possible for a respiratory infection to trigger diabetes. I also remember them asking if my son had ever been treated with steroids. He was treated with steroids to help control his croup. Since this disease does not run in our family, could the croup or the steroid treatment have caused his diabetes. Therefore, if it was not my son’s body that destroyed his islet cells, but the infection or the steroids, would it be possible that his body may not reject a new set of islet cells if they were transplanted into his pancreas?


From: DTeam Staff

Current theory is that the development of Type 1A or autoimmune diabetes is the result of both an inherited predisposition and an environmental factor. The latter factor is not yet clearly defined although the early ingestion of a certain subspecies of cow’s milk (one that contains A1+B beta casein) has some support and in contrast early supplementation of vitamin D may be protective. There is also evidence that the process of immune damage may start in utero. The fact that there is no family history on either side is common and means that the genetic predisposition was not triggered by any environmental factor. The croup and the steroids may have accentuated the pace of the autoimmune damage but would almost certainly not have initiated it.

You are correct in supposing that this same process would reject an islet cell transplant and a great deal of research is going on in ways to prevent this either through a protective encapsulation of the transplanted islets, or by new immunosuppressive therapies or by modifying the recipient’s own immune response. To date, though, the procedure has not reached the point at which it can be recommended for children. However, new insulins, new dosage regimens, the prospect of early noninvasive glucose measurements and more distantly of an artificial external pancreas increasingly are making possible a much stricter control of blood sugars and thus a much diminished risk of complications.

Additional Comments from Dr. John Schulga
The milk theory is at the moment still speculative and not proven, as is the protective effect of vitamin D. With regard to steroids in croup, only a very short course (1 to 3 days) is used, and I think that the likelihood of the steroids contributing to the onset of diabetes is extremely unlikely.

Often the fist signs of diabetes in the family is a child in the family developing diabetes. This is often the case in about 80% of cases. It does sound that your child has developed autoimmune
diabetes. Checking antibodies will give you evidence of this.