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Question:

From Atlanta, Georgia, USA:

My brother was recently diagnosed as having diabetes. What information would definitely give you some idea of whether he's Type 1 or 2? What is the difference between a Type 2 who takes a bit of insulin and a Type 1 with residual insulin production?

Can I also assume, since my brother has diabetes, and my mom's brother is a Type 2, and my mother's sister's son's son (my cousin) has Type 1 that this hereditary factor could be the reason why my son has Type 1 diabetes? I tested negative in the DPT study as did my mom. So far we are the only ones on either side that participated in this. My husband and I are not looking for blame, we just want to understand, in layman's terms, where it could of come from!

Answer:

Since the DPT-1 laboratory was willing to test you and your mother on the basis of having a first cousin with Type 1 Diabetes, I am sure that they would be willing to test your brother even though he has already developed clinical diabetes. In terms of practical management, there is not a lot of difference in managing insulin dependance whether it is due to Type 1 or Type 2 diabetes. If your brother has Type 1 he may for quite a long time require much less insulin (the honeymoon period) but ultimately the need will become permanent (at least until islet cell transplants become practical). If he is Type 2 and now requires insulin it is possible that he might be helped by one of two new oral drugs, metformin, which controls blood sugar by reducing the output from the liver, and troglitazone which will not be available for another two months, but which increases receptor sensitivity to insulin. It would be important to discuss this with his physicians and a reason perhaps to differentiate between Type 1 and 2.

A different set of genes are involved in Type 1 and Type 2. Without knowing at what age your uncle became diabetic or whether he now requires insulin, it is just possible that he is Type 1, cases have been described with onset in their 40's. If this was so it might more easily explain the distribution of diabetes in your family although Type 2 diabetes is a common condition and might easily occur randomly in association with Type 1.

DO'B

Original posting 11 Feb 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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