My daughter is 10 years old. Recently, after recovering from a virus she developed increased thirst and urination. A diagnosis of Type 1 diabetes was made. On diagnosis her blood glucose was 25 mmol and her HbA1c was 10. At no time has she had ketones in her urine, in fact upon diagnosis she was quite well and only very minimally dehydrated. She is now on insulin twice daily and is in the honeymoon phase. She is obese. My question is this; we have no family history of diabetes in the family going back for a couple of generations. We are hoping that she has Type 2 or if in fact this thing can actually go away with weight loss and diet.
There are several possibilities to account for your daughter's story. the most likely is that she is indeed what is now called Type 1A or autoimmune diabetes. You should talk to her doctor about getting an antibody test done to confirm this diagnosis. The fact that your family history is negative does not discount this probability.
There are some other diagnoses to consider though. One is that she has what is called Type 1B diabetes. This has a typical onset initially; but after a number of weeks insulin may no longer be required and in some cases diet and exercise may be sufficient management. This type is seen in less than 10% of Caucasian families. Another possibility is that she has got one of the four different varieties of Maturity Onset Diabetes of the Young (MODY) which again, especially if it is MODY2 or glucokinase deficiency may be manageable without insulin. There are some other very rare conditions to think of like mitochondrial diabetes; but with no other special problems they would be very unlikely.
What is tiresome about all these rare subtypes is the difficulty and cost of pursuing a specific diagnosis, because the tests are for the most part carried out in very specialised research laboratories and even in the U.S. there is no central facility. However I think the diagnosis of Type 1 is important and I know that there are laboratories in Canberra and Melbourne that can do this. A telephone number in the U.S. that could help you is 1-800-425-8361.
In the case of autoimmune diabetes it is important to accept that insulin treatment will be lifelong or until an effective solution to islet cell transplantation can be worked out and subsequent good control is critical. For the other possibilities the particular diagnosis is not really critical for management at least until much greater experience tells us differently.
Original posting 3 Sep 1998
Posted to Diagnosis and Symptoms
Last Updated: Tuesday April 06, 2010 15:09:00
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