December 23, 2003
Diagnosis and Symptoms
Question from Milford, Michigan, USA:
My son was diagnosed with type 1 diabetes in 2000. He was sick with stomach pains and vomiting with fever. We took him to the emergency room and they did a test and came back with type 1 diabetes. That night he was taken by ambulance to Children's Hospital of Detroit and they confirmed he had type 1 diabetes. We went through almost two year of the rigors of diabetic life. He was on insulin for approximately one month, and we were testing blood sugars two or three times a day. We were also seeing the endocrinologist every three months for meter readings and so on. His blood sugar readings were never really abnormal, and the last time we took him for his three month checkup, which was around the two year mark, the doctor told us that our son doesn't have diabetes. I asked if he ever had it and he said he didn't know. Have you ever seen or heard of this happening? Could his high blood sugars have do to with another illness, or could he have had it and and outgrown it, or could it have simply been a misdiagnosis?
For many years it was customary to refer to any child who developed acute insulin dependance as having Type 1 Diabetes. For the last decade however it has been recognised that there were several components to this entity. By far the commonest in Caucasian families was Type1A or Autoimmune Diabetes and it was considered important to make this diagnosis specifically because of its strong links to other autoimmune conditions, especially hypothyroidism and celiac disease. This confirmation was achieved by doing a trio of antibody tests, specifically anti GAD, anti insulin and ICA512, two of which had to be positive to confirm the diagnosis.
About 5% of Caucasian new onset cases and just over 50% of African American and Hispanic new onsets however were antibody negative and have come to be classified as Type 1B or Idiopathic Diabetes. The importance of distinguishing this group is that about half of them come to be able to control blood sugars without insulin, although some may still need oral medication or just diet and exercise. The underlying pathology is not yet understood; but it seems that they are insulin deficient, an indication that at some later stage they may again need insulin. I suspect that your son belongs in this group. Finally some of the insulin resistant syndromes including Type 2 and the Mitochondrial diabetes’ may also uncommonly present in this manner.