From Michigan, USA:
We have a 13 year old son diagnosed two months ago with type 1 diabetes. I have several questions I would like a answer on; and yes, we have been to a specialist.
- When first diagnosed, we were told it may be a hormonal imbalance causing the symptoms. How do we know that is not the case?
- How is it determined that he has type 1 rather than type two?
- How do you test the pancreas to evaluate how much insulin if any it is still producing ?
- Why are drugs such as Prandin or Amaryl [medications for Type 2 diabetes] not used to stimulate the pancreas while it is still producing insulin, such as in the honeymoon stage?
- Where do we go to find a fix such as a transplant or cell implants rather than just controlling diabetes?
I thought it would be easiest to answer your questions one by one.
- I believe that you may not have quite understood what the endocrinologist meant by 'imbalance'. In Type 1 (autoimmune) diabetes, the only hormonal disorder is the eventual destruction in almost all cases of insulin production. This does of course lead to adaptations by other hormones that control blood sugar but this is a compensatory mechanism and not in itself abnormal. In adolescence also there are also normal hormonal changes, some of which affect blood sugar and these changes are sometimes invoked to explain erratic glucose control in teenagers.
- Type I is differentiated from type II primarily by finding certain specific antibodies in the serum. Your son's endocrinologist may well have already done this test and could explain it to you. There is also a Type 1B form of diabetes in children especially those who are African American or Hispanic who are antibody negative and who often do not remain insulin dependant. Some forms of Type 2 diabetes may also occur in children especially where there is a strong family history and a degree of obesity.
- Any residual insulin producing capacity can be evaluated by either a C-peptide test on serum or by doing an intravenous glucose tolerance test. They are expensive to carry out and for the most part used only in clinical research projects.
- In Type 1, drugs like you describe only shorten the period until insulin production is completely exhausted. Sometimes drugs like metformin which reduce glucose production in the liver can supplement insulin treatment.
- Pancreas transplantation and islet cell transplantation for Type 1 Diabetes is not available for children partly because of the necessity for complex immunosuppressive treatment and partly because neither the long term nor the short term results justify the procedure
Last Updated: Tuesday April 06, 2010 15:09:01
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