From Houston, Texas, USA:
My 7-year-old daughter was diagnosed with diabetes about 6 weeks ago. Her endocrinologist says, tongue-in-cheek, that she's a Type 1-1/2, as she's a chubby child, not on the thin side as the endocrinologist says most Type 1s are; however when she was admitted to the hospital she was definitely in diabetic ketoacidosis in critical condition. Currently she takes insulin, 1 unit Humalog/4 units NPH before breakfast; 1 unit Humalog/3 units NPH before dinner. At this time we have very good control of her blood glucose level; most likely she's in her honeymoon period.
The endocrinologist said she could envision trying to use the diabetes pills instead of insulin in the near future to see if it works since she thinks my daughter is so atypical of a Type 1. However, I see from another letter, where a parent asked about the wisdom of using both insulin and Glucophage on her 17 year old son, that it was advised against using this drug on a Type 1. If we do try the drug, and she's truly Type 1, what complications/problems could we expect?
My question then is, should I even allow a trial with Glucophage or a like drug for my daughter? My understanding is that children as young as 7 are rarely Type 2; and that her condition at time of admission to the hospital was what you'd expect from a Type 1 in crisis.
In the last few years the various types of new-onset diabetes in childhood have come to be more clearly understood. For those that have an acute onset with ketoacidosis it is important to have an antibody test to decide if they have autoimmune or Type 1A diabetes. If this test is positive, the treatment is daily insulin until such time as islet cell transplants become an option and good control is all important. The temptation to stop insulin during the honeymoon period should be resisted.
About 10% of Caucasian children and about 50% of Hispanic and African American new onset are not antibody positive. The distinction is important because many of these children, even if they have ketoacidosis at the onset, can be managed without insulin after a number of weeks. This latter group are said to have Type 1B diabetes. Some of these children have chromosomal abnormalities but for the most part the underlying pathology is not yet understood. There are other subgroupings to consider; but they seldom present with ketoacidosis. They are also rare and include the various forms of MODY or Maturity Onset Diabetes in the Young and mitochondrial diabetes. At one time the term Type 1 1/2 was applied to MODY because many of them were overweight and like Type 2 Diabetes, did not need insulin.
I hope this helps to clarify things: the essential is the antibody test.
Last Updated: Tuesday April 06, 2010 15:08:58
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