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Question:

From Watchung, New Jersey, USA:

Our 15 year old son was diagnosed 2 years ago with type 1 diabetes (sugar found in urine during a routine camp physical; confirmatory blood glucose readings were in the 500 range). However, he was asymptomatic, weighed 145 pounds, was 5'9" tall, and had no antibodies (yet there is a strong history of type 2 diabetes on the maternal grandmother's side of the family). He was quickly and efficiently brought under control within two days of initial diagnosis, and for the past year and a half has been doing extremely well on 3 units of Ultralente a day. Six weeks ago, he was switched from insulin to Glucophage [metformin, a pill for Type 2 diabetes] (1000 mg. a day) and his numbers range from 70 to 105 (on occasion, (three hours) after a Chinese food buffet his numbers can go up to 205; however, he awakens with a number of 94 in the A.M). So we know he needs some form of medication.

We remain skeptical that our son has type 1 diabetes. In your experience, what is the longest honeymoon period you have encountered (without showing antibodies; recently, he was tested for antibodies and is not producing any after two years). We have encountered difficulty finding a site that will do genetic testing for MODY. Do you have any suggestions for contacts? Are there any other options for consideration other than type 1 or MODY? What does this sound like to you?

Answer:

It sounds as though your son has what is now called Type 1B Diabetes. These are children who present with typical insulin dependant diabetes; but they are antibody negative. This is rather rare (less than 5%) in Caucasian children; but comprises over 50% of new-onset Hispanic and African American children. Exactly what the molecular defect is is not yet known; but some have chromosomal abnormalities. The good news is that many can come off insulin in the ensuing months and can be managed, as your son has been, on oral medication. In some cases even diet and exercise may be sufficient. Because of the early insulin dependance, this classification is perhaps more likely than one of the many forms of Maturity Onset Diabetes of the Young (MODY). Also it probably is not known exactly what form of diabetes was present in the family history: it could well be the same as what your son has; but proving the matter would require some rather expensive laboratory work.

In contrast to Type 1A or autoimmune Diabetes, there is a good chance that young people with Type 1B Diabetes will no longer stay insulin dependant after the first few months and they may even be controllable on diet and exercise alone.

DOB

Original posting 23 May 1999
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:04
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