My two and a half year old daughter was diagnosed with type 1 diabetes about four months ago. Her blood glucose has never been above 160 mg/dl [8.9 mmol/L] (that was in the hospital), and all tests came back high normal except for the islet antibodies which was 7.3. The doctors have all told me she has diabetes, caught so early that she is showing no symptoms (except excessive thirst and urination). An urgent care visit for a high fever brought up this fact and the staff there looked at me like I was crazy when I mentioned this to them. Now I am doubting myself and the fact that she has this disease. Can you give me any help in when I can expect the disease to show up? Any clarification would help.

By far the most probable diagnosis is that your daughter has type 1A (autoimmune) diabetes. In this complex disorder, the slow erosion of the islet or insulin producing cells in the pancreas starts months or years before insulin dependence develops. During this period, a minor intercurrent infection can precipitate a short lived episode of clinical diabetes and for the rest of the time there may or may not be symptoms and signs like failure to gain weight. Delayed excretion of insulin from damaged islets may even cause hypoglycemia. Inevitably though. there comes a point when the islets are over 90% destroyed, and insulin is then required on a permanent basis.

The antibody test is a useful discriminant from other forms of diabetes during this period. You might think to ask the doctor whether in her case the test was the immunofluorescent screening test which is simple, but not entirely free of error or whether it was the current battery of anti-GAD, anti-insulin, and ICA512 antibodies, which is more precise. You might also want to discuss whether there is a case for starting oral nicotinamide with the idea of delaying the need for daily insulin. It would be worth calling 1-800-425-8361 to see if there is any possibility that she could be accepted into the oral insulin phase of the national DPT-1 trial even though she has no first degree relative with the disorder.

Finally, I think that you do need to keep monitoring glucose levels occasionally, both fasting and two hours after a meal because there is a case for starting with very small doses of NPH or later this year Lantus (insulin glargine) insulin even at this stage.

DOB