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October 20, 2000

Diagnosis and Symptoms

Question from Newell, Alabama, USA:

Our seven year old son was diagnosed with type 1 diabetes three years ago. He hasn't, to date, had any problems. On one of our most recent visits to his diabetes clinic, we were told that his body may still be producing insulin. He requires very little insulin compared with his height and weight. Can type 2 treatment be used for him?


In the last few years, it has become clear that acute new onset diabetes in childhood may have several origins. In North America and in Western Europe, by far the most common form is now known as type 1A or autoimmune diabetes, and insulin in some form has to be given at the onset and for life. These cases can be confirmed by a positive blood test for certain specific antibodies.

However, in about 5% of Caucasian children and as many as 50% of African American and Hispanic children, the antibody test is negative. More importantly, after some months, they no longer require insulin, and their diabetes can be managed with diet and exercise supplemented, as needed, with oral hypoglycemic medications. The underlying cause of type 1B is not yet understood, though some have been shown to be linked to chromosomal abnormalities.

There are some other very rare forms of diabetes that could be included in this category, and type 2 diabetes, itself, is becoming increasingly common in childhood, but it is frequently associated with obesity and is not, usually, insulin dependent to begin with.

I would think that your son probably belongs in the type 1b group. Working with his doctor, it might be possible to contain his glucose intolerance without insulin. Many in this category do seem to still have some degree of insulin insufficiency, so it is possible that he will again need insulin in the hopefully distant future. In any case, the exact specification of what kind of diabetes he has is much less important than learning to maintain good control by the simplest means possible.