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Question:

From Garner, North Carolina, USA:

My two year old daughter was diagnosed with diabetes about a month ago, and prior to this she was on steroids for five days. The symptoms of drinking and urinating a lot appeared during the last two days of steroids, so she was tested and diagnosed immediately. Her A1c was 7% and her insulin was 4 (I'm assuming this was the C-Peptides test). Now, two weeks later, and for the second time her insulin has been discontinued and levels are great. She was on 0.25 U of Ultralente once a day before breakfast which kept her glucose levels in the 40-90 mg/dl [2.2-5 mmol/L] range. Our doctors tell us she is in a honeymoon, but needs insulin to support her pancreas and to extend this period as long as possible. Their next step is to possibly dilute her insulin and resume injections. Is there a possibility this could have been a false positive because of all the medication she was on prior to diagnosis?

I just need reassurance that my daughter has diabetes and is in the honeymoon phase. I am dealing with the reality that my baby has diabetes and that is okay, but as others, I'm sure at this point, I'm confused and want to know if there is hope that she could have been misdiagnosed.

Answer:

If the lab was tied to the DCCT. standards (most labs are these days), then 7% was high for a hemoglobin A1c. The 4 is likely a C-peptide and certainly not low since it was measurable. C-peptide is low in type 1 diabetes, but not always at diagnosis.

You might ask for your daughter's doctor to do other tests: islet cell antibodies, anti-GAD antibodies, and anti-insulin antibodies. If positive they help with a positive diagnosis, but many children are negative -- nothing is perfect.

I don't think anyone can be absolutely certain that your daughter is in a honeymoon from a very early diabetes diagnosis. Does insulin treatment preserve pancreatic function? At the University of South Florida, Shah took new patients with diabetes and placed them on IV insulin several times in the first year after diagnosis, and his data seem clear that insulin treatment preserves pancreatic function. This is the premise of the DPT-1, and. we'll hear about the diabetes prevention trial in a few months at the American Diabetes Association meeting. I believe it will work as I had kids in the preliminary trial who still are not on diabetes doses of insulin, but the data are not in as of yet for sure.

What to do now is not clear to me, but if you don't want to give insulin now, a diagnosis might become clear shortly. The pancreas will be harmed though. This is most difficult as a parent and not an easy decision. I'm not sure there is a single test to give the right answer.

LD

DTQ-2001033022584
Original posting 16 Apr 2001
Posted to Diagnosis and Symptoms and Honeymoon

  
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Last Updated: Tuesday April 06, 2010 15:09:20
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