June 7, 2005
Diagnosis and Symptoms, LADA and MODY
Question from Jensen Beach, Florida, USA:
The diabetic educator my son sees has suggested he might have the MODY type diabetes. Is there a test for this? He has been diagnosed for less than a year and never has high blood sugars. He is usually around 80 mg/dl [4.4 mmol/L] and his A1c is below 6.0. He does not have the antibodies for type 1. He presently injects twice a day, seven units of long-acting insulin and one-half a unit of short-acting insulin. He has never had ketones, even at diagnosis when his blood sugar was over 700 mg/dl [28.9 mmol/L]. There is a family history of diabetes, both type 1 and type 2. We have only one pediatrician in our area and she says it doesn’t matter what type he is, that he needs insulin. But, the educator in her office thinks maybe he should be on oral management. What is your opinion?
It sounds like the educator and the physician need to have a conference to see what is going on and what they really believe/recommend. There are some genetic tests available for an MODY diagnosis, but they are so new that there’s not much experience with them. Ultimately, insulin doses are decided by blood glucose response. Antibody tests help with a more exact diagnosis only if positive; if negative, they won’t tell you if you have autoimmune type 1 diabetes. When there are negative tests for the antibodies, which occurs about 60 to 80% of the time, it’s not clear if they are really negative since there is no antibody present. Analysis of family history, obesity, other autoimmunopathies present can sometimes help give some clues to which diagnosis as well. What happens to blood sugar control over time is also helpful. But, go back and ask that the doctor and the nurse discuss this together and with your family together as well.