My nine year old son was diagnosed six months ago with a fasting blood sugar of showed 250 mg/dl [13.9 mmol/L] and some ketones, but no antibodies. Since he started insulin injections, exercise, and a meal plan, his insulin requirements have steadily decreased and finally, early last month, he became completely off of insulin! For the last two months, he has been doing just fine without injections (with morning and before-meal blood sugars l of 90-100 mg/dl [5-5.5 mmol/L] and postprandial levels of 120-150 mg/dl [6.7-8.3 mmol/L] after meals).

We are Asian and my son is bigger than the average. Based on your responses to other questions here, I guess my son can have either type 1B or type 2. Our endocrinologist isn’t 100% sure of his type, but suggests that he doesn’t seem to have type 1A with a “honeymoon.”

Our biggest concern is whether there will come a time when he will need insulin again. Will my son eventually need insulin again? How do we prolong this period of insulin independence?

Assuming that your son was tested for a conventional array of antibodies, that is to say anti-GAD, ICA512, and anti-insulin and all were negative, then by present definition he cannot be in the honeymoon phase of type�1A (autoimmune) diabetes. This does not entirely exclude the presence of a so far undefined auto-antigen.

There has been a worldwide increase in the incidence of type�2 diabetes in children, but they do not usually present with acute insulin dependence, and it is common for them to be overweight at the time of onset and there is usually a family history of type 2 diabetes. They would also have a near normal or even a high serum C-peptide level.

This said, your son would appear to have type�1B (idiopathic) diabetes. I have not been able to find any population studies for this form of diabetes in Asian families, but there are certainly reports of small series and the development of insulin independence after a few months is typical.

Such little evidence as there is suggests that these children do have diminished insulin reserves and may therefore need insulin again at some time in the future. The difficulty in deciding how to prolong this phase is that the precise pathologies of this kind of diabetes are not yet understood and even the definition of type 1B is such a recent one that long term histories are not yet available.This being so, all you can do is to try to maintain normal body weight and take lots of exercise and perhaps in the future get help from oral hypoglycemic agents like Glucophage [metformin].

DOB