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Question:

From Royal Oak, Michigan, USA:

My 4 year old son was recently diagnosed with pre-clinical diabetes. His fasting plasma glucose was 85, 2 hour value on a oral glucose tolerance test was 218, and 3 hour OGTT was 110. His endocrinologist has put him on 0.5 units R and 2.5 units UL in the morning and 1 unit of Lente at bedtime. His stated objective is to rest the islet cells, inhibit the autoimmune response and possibly extend the "honeymoon" period. He has another patient on a 5 year "honeymoon". Do you have any information on the effectiveness of this early onset insulin therapy? Statistics, expected blood glucose levels, etc.?

Answer:

I would assume there was additional evidence from fasting blood sugar levels and/or glucosuria that you did not include.

In the case of your 4 year old son I think that in this center we might have opted for some further tests before starting insulin on the basis of a single abnormal 2 hour OGTT, especially with a normal fasting level.

The benefit of insulin in the predabetic phase of Type 1A or autoimmune diabetes is not yet established; but the priliminary evidence was suggestive enough for the NIH to support a big national trial which is called DPT-1. It looks as thought the bsnefit is related to the number of antibodies present, for example with only one antibody, greater than 90% of cases would still be off insulin after five years. With three antibodies, most children would have clinical diabetes by the end of this period. There is also some evidence that oral insulin may also be effective. For these reasons I think you should discuss with your son's doctor whether it would be important to get antibody tests done as soon as possible. The number to call for details is 1-800-425-8361. If the test is positive, this confirms Type 1A autoimmune diabetes and it would be entirely justifiable to continue with insulin and you might indeed wish to enrol your son in the DPT study. If on the other hand the test was negatve then there would no longer be a rationale for continuing insulin until it was needed clinically. One reason for this is that an antibody negative Type 1B diabetes is now recognised as a separtate disorder. It is most common in African American and Hispanic children but does occur in about 10% of Caucasian children. In many of these cases insulin may no longer be required after a few weeks.

DOB

Original posting 31 Dec 1998
Posted to Research: Causes and Prevention

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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