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Question:

From Lakewood, Colorado, USA:

My son, who is 5 years old, was diagnosed with Type 1 diabetes about 4 months ago. He is taking 5 units/day of insulin and weighs 53 lbs.

We took part in a study at the Barbara Davis Center and found that neither my wife or I have the DR3/4 gene -- and neither does my son (the one who has been diagnosed).

My first question is: Since (1) there is no "forcing function" in his body causing the diabetes and (2) he is still making over 80% of his insulin, is there anything that we might try to either prolong his "honeymoon" or turn off production of the antibodies that is causing the diabetes?

My second question is: When we first took him in his HbA1c was 11.9 and his blood glucose was over 600. Last time we measured this (last month) his HbA1c was 6.0 and his average blood glucose has been in the low 100's. Is there any other disease that can have these same symptoms?

Answer:

When genetic patterns are assessed in new onset cases, only the commonest susceptible genes are looked for at the moment. There are a number of other patterns which also vary with a family's genetic origins. For instance the patterns of susceptibility in Norway are different from those in Spain. You should in any case be sure to have any other children in the family tested for antibodies because they then might be eligible to take part in a prevention trial called DPT-1.

There have been many trials, attempting to modify the abnormal immune response and to halt or ameliorate the gradual destruction of the islets. This may still be successful if clinical diabetes has not yet started, as in DPT-1; but attempts that have any effects at a later stage have been very disappointing. At one time the drug Cyclosporin looked promising; but then it turned out to be toxic to the kidneys. The objective now is to maintain the best possible control, and it certainly seems that you have achieved this so far and to hope that some form of islet cell transplantation may one day offer relief from daily injections.

With a positive antibody test there can really be no doubt about the diagnosis though there are, of course, other forms of diabetes, mostly rather rare, that can occur in the this age group. Cystic Fibrosis is one and there is a spectrum of genetic disorders including the three forms of Maturity Onset Diabetes in the Young, the mitochondrial diabetic syndromes and the various forms of diabetes associated with malnutrition. There is another group of disorders, again rather rare, that produce diabetes by increasing insulin resistance rather than by reduction of insulin production; but in these cases there is no antibody production.

DO'B

Original posting 11 Oct 97

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