July 5, 2000
Diagnosis and Symptoms
Question from San Jose, California, USA:
My son is 7 years old and was diagnosed about one month ago with Type 1 diabetes. He is very thin, active in sports and eats well. There is no family history of Type 1 or 2 diabetes. His blood tests came back showing negative antibodies to his pancreas. His thyroid test was normal. I have several questions: 1) Should I be concerned about an underlying issue and request some further tests? 2) Is this unusual? What percentage of people with Type 1 diabetes have no antibodies? In general, my son has been very healthy. Last autumn, he decided on his own to get the flu shot (he hates throwing up). His pediatrician said it would be fine. He appeared perfectly healthy before the shot, however, within 3-5 hours after the shot he was running a temperature of 105. He continued to have a high temperature for a few days with no other signs of illness. I know this could be just a coincidence that he got a fever after the flu shot, but I recall him getting quite ill very quickly as well as not regaining full energy until after being diagnosed with diabetes. My related questions, however, are: 1) Is it possible that the influenza shot damaged the pancreas? 2) Is it possible that the diabetes is secondary due to damage to the pancreas caused by an illness?
Your concerns about your 7 year old are appropriate. Let me clear up a few issues for you however. I would not be concerned about an underlying issue at this time if he is responding well to insulin therapy. The test for insulin antibodies is not a perfect test and can occasionally be negative even in a child with newly diagnosed Type 1 diabetes. In my practice, it is usually more useful as a screening test for family members of children with Type 1 diabetes and indeed a nationwide study is being done screening family members of children with Type 1 diabetes using pancreas antibodies (specifically–islet cell antibodies). For more information, you might check out the information at DPT-1
In addition, 10-15% of children with Type 1 diabetes eventually develop an easily treated condition of the thyroid gland called “autoimmune thyroiditis”. This can develop at any time during one’s life with diabetes. Screening thyroid hormone levels will be done at regular intervals (I do them once a year in my kids with diabetes) to help detect this occasional problem.
The flu shot has not been confirmed as a cause of diabetes — certainly there are many theories regarding what causes diabetes and the flu shot is one of them, but so far there is no clear evidence implicating a certain cause. Certainly, I would encourage you not to feel the least bit guilty about his receiving a flu shot — and indeed, I would encourage you to have him get a flu shot every fall now that he has diabetes.