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April 26, 2001

Daily Care

Question from Johnston, Iowa, USA:

Our three year old daughter was having symptoms of diabetes after a serious bout of E. coli six months ago, and we have been treating her with 2 units of NPH in the morning and 1 unit at dinner time. Recent blood tests revealed that she does not have any antibodies, so now the doctor at the university says she does not have type 1 diabetes. She said to talk to our regular endocrinologist about replacing the shots with pills and that there may be a chance that her body will still come out of this. Any thoughts?

Answer:

I think that the most likely explanation of your daughter’s story is that she has what is now called type 1B or idiopathic diabetes. In children, the onset of this is usually acute and insulin dependant just like in the more common type 1A (autoimmune) diabetes, but the antibody tests are negative.

In about 50% of these cases, insulin can be discontinued after some weeks or months, and the blood sugar pattern controlled by oral hypoglycemic drugs like metformin. Sometimes too, control can be achieved by dietary and exercise control which is impractical in a three year old.

The underlying cause(s) of this are not yet understood. It is only appears in about 5% of new onset Caucasian children, but, in Hispanic and African-American new onset cases, it occurs in just over 50%.

As to ‘growing out of it’, there is now some preliminary evidence that the ability to make insulin is indeed compromised and that at some late stage insulin may again be required.

DOB