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Question:

From Monroe, Connecticut, USA:

My 14 year old son was recently diagnosed with diabetes. The doctor is not sure about the type yet but believes that it is behaving like Type 1. However, his glycohemoglobin is 6.8 and his ICA test and one other antibody test (I can't recall the name) are both negative. His 4 hour glucose intolerance test indicates that his tolerance for glucose is impaired but his readings without insulin and diet range between 126 and 180.

It first came to our attention as hypoglycemia after he had an episode at noon in school after missing breakfast. After a week of readings, however, it was clear that his readings were in general elevated. The doctor has placed him on longacting Lente in the morning (5 units) and the late afternoon (3 units) to "rest" his pancreas. With some diet modifications, his average readings are definitely more regulated and his modal reading has been between 120 and 125). He is slim and athletic. The only glucose problem in his family history is a maternal grandparent with a possible Type 2 which was controlled by diet. The doctor still thinks it is Type 1 and not Type 2 because of his weight. Can it be Type IB (MODY) and if it is what is the prognosis? (He is Caucasian).

Answer:

Since your son was initially insulin dependant, but was also antibody negative, the most likely precise diagnosis is that he has Type 1B diabetes. This is rather uncommon in Caucasian children (<5%); but comprises just over 50% of new onset cases in Hispanic and African American families. There is a good probability that within the next few months he will be able to come off insulin and be able to control his blood sugar with oral medication or even, eventually with diet and exercise. The precise molecular nature of this form of diabetes is not yet understood although some of them are recognized to be associated with chromosomal abnormalities. One of the various forms of MODY is less likely because he required insulin to begin with. In any case, the long term prognosis for the advent of complications is good.

DOB

DTQ-19990407155039
Original posting 11 Aug 1999
Posted to Diagnosis and Symptoms

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