At the time of his diagnosis, 21 months ago, my now 11 year old son had an hemoglobin A1c of 10%, a GAD antibody level of 7.0, and an islet cell antibody level of 0.75. He has been taking two injections per day of 7 Units NPH with 3 Units of Regular, weighs about 70 pounds, and is very active. His doctor says his control is excellent since his last A1c was 5.6%.

I decided to have his C-peptide level checked, and it was 0.9, although low it is still in the “normal” range. Does this sound right? I know its possible he may still be in the honeymoon, but is this probable? Is the autoimmune process always complete?

I am sure that your son has type�1A (autoimmune) diabetes, and although it is some unusual to have a C-peptide at the lower limit of normal at this stage, it is not so very uncommon for the honeymoon period to persist for two years or so.

It might be worth pursuing the interpretation of the anti-GAD and islet cell antibody results because laboratories are now supposed to report antibody tests in diabetes as positive or negative and not as a number. A positive test would be one that is at the 99th percentile above the mean normal value and thus predictive of diabetic autoimmunity. Although time will tell the precise diagnosis, it is of importance because it implies that some form of insulin supplementation will be needed for the rest of your son’s life.

In one sense, the autoimmune process is never complete because grafted islet cells need continuing immunosuppression. indeed, there is some interesting new evidence that the pancreas can continue to bud new islets from duct tissue for a very long time.

DOB