How do you differentiate between Type 1 and Type 2 diabetes in children if antibody testing has not been performed? Is it worthwhile to try oral medication in children instead of insulin to see if they respond?
The antibody test, if it is positive, provides an immediate confirmation of what is now known as Type 1A or autoimmune Type 1B diabetes by far the commonest form of diabetes in young people. In a small number of Caucasian children and in over half the new onset cases in children who are of Afro-American or Hispanic descent in the US, the antibody test may be negative even though they present initially as insulin requiring: many of these children can however be managed without insulin after a few months. Otherwise it is hard to tell the difference between Type 1 and Type 2, especially as nowadays what used to be termed Type 2 can be much more precisely diagnosed by some even more specific laboratory tests: e.g.for the various forms of MODY (Maturity Onset Diabetes in the Young) or for mitochondrial diabetes.
Some years ago it was fairly common to discontinue insulin and try oral medication during the honeymoon period; but all that really did was to shorten the period of diminished insulin need. I am afraid that you have to accept that at the moment a diagnosis of Type IA diabetes involves a lifetime commitment to insulin. Later on, however, you might want to talk to your doctor about using metformin [a pill usually used for Type 2 diabetes] in addition to insulin as a possible means of getting even better control.
Original posting 2 Apr 1999
Posted to Diagnosis and Symptoms
Last Updated: Tuesday April 06, 2010 15:09:02
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