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October 28, 1999

Blood Tests and Insulin Injections, Diagnosis and Symptoms

Question from Melbourne, Australia:

My son is 12 and was diagnosed with Type 1 diabetes one month ago. He also suffers from Asperger's Syndrome and has an eating disorder, narrowing down the variety of his foods. He basically lives on bread, fries, apple juice and non-fat milk. I'm confused by the blood sugar readings in other letters written to you. I use a meter that states that it measures mmol/l. I'm told that any reading below 3.5 should be treated as a hypo, but his blood sugar rarely goes above 6.0. His insulin does has been slowly decreased over the month, and yesterday his Diabetes Registrar stated that "he appears to be regaining some pancreatic functioning". Have you ever heard of that? Is it possible for his pancreas to start working again?

Answer:

The most probable diagnosis in your son, apart from that of Asperger’s syndrome, is that he has Type�1A (autoimmune) diabetes. This could be confirmed by doing an antibody test which is certainly available in the Children’s Hospital; but I don’t think that is necessary.This autoimmune process has almost certainly been slowly destroying the ability of the beta cells in the islets of the pancreas to make insulin over a number of years.What happens when exogenous insulin is given after the clinical stage has developed is that there is a transient restoration of the ability to make some of his own insulin, a process that is called the ‘honeymoon period’. It may last from a week or two to over a year; but insulin by injection should not be discontinued. At this stage you might be helped by reading Understanding Insulin-Dependent Diabetes by H. Peter Chase, M.D.

As to the blood sugar issue I would agree with the lower limit of 3.5 mmol/L; but with a diabetic at this stage I think you should initially accept up to 9mmol/L for the higher limit.

P.S. Possibly the reason that you have been puzzled over blood sugar readings is that in Europe and in Australia and New Zealand the units for measuring blood sugars are expressed as mmols/L. In North America the the units are mgm/dl; 1 mmol/L is equal to 18 mg/dl.

DOB

[Editor’s comment: See http://web.syr.edu/~jmwobus/autism/links-aspergers.html for additional information about Asperger’s Syndrome.

JSH]