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February 13, 2010

Diagnosis and Symptoms

Question from Michigan, USA:

In October, two weeks after he had the flu, I took my son to the doctor for a follow-up and since I'd noticed he was urinating more urgently. They tested his urine first, then his blood sugar. Within seconds, the doctor came in and said, "You need to take your son to the hospital." His blood sugar was 430 mg/dl [23.9 mmol/L] and he had ketones in his urine. It all happened so fast and there were no signs at all before this illness. In the hospital, his A1c test was 8.3 and they said it only went back with highs for around two weeks. They started him on fast acting and long acting insulin. They are telling me now he is in a very good honeymoon phase. He only requires 1.5 units of Lantus daily and a carbohydrate ratio of 80. There is no family history at all for type 1 or type 2 diabetes. On December 8, 2009, we did a GAD test. I was told the results take six to eight weeks. We just received our results and they said he tested positive for all three antibodies. He is type 1, not 2, and we were convinced he had type 2. I am very confused! The results were given over the phone. At our next appointment, I want to ask the right questions. With all my reading on this type of tests, I am not assured this is 100 percent. Can I still have hope they are wrong and could the test be wrong? I know viruses can trigger diabetes and many other illnesses. Should we ask for a C-Peptide test? His A1c today was 6.3. I have also heard of antibody injections for newly diagnosed patients can help; could this be an option for a cure?


It seems like all the proper testing was done and it is unlikely that there are three errors in the antibodies. Exactly why one develops diabetes is an area of intense research and we know that type 1 diabetes has genetic components but often does not run in families in the same way that other illnesses do. A child this young almost always has type 1 autoimmune diabetes mellitus and needs insulin for life. It is good that he was not so sick and good that it was caught in time. It sounds like his treatment has done exactly what it is supposed to do and if he has reached a stable honeymoon phase, that is also a good thing. So, I am afraid that you are not likely to see this as type 2 diabetes unless your child is extremely obese. Even then, with three antibody levels positive, this is most likely type 1.

If you have some interest in volunteering for research programs, you should discuss this with your diabetes team. There is more information at the JDRF web page on clinical trials, the ADA web page on News & Research, and the CWD page on Studies.