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From Port Angeles, Washington, USA:

I have two young children with diabetes. My son, who just turned seven, was diagnosed last December and now our three and half year old daughter was just diagnosed last week. We where told that she only had a 6.6 percent chance of also getting it. Is this true and are there many sibling groups who have type one?

I also read recently that there is type 1A and type 1B. It this true and where can I find out more information on this?

Have you every had a dedicated mom be able to get her children off of insulin injections, by carbohydrate intake, exercise, etc.? If so, I would like to know where to find more information on how.

Sorry for all the questions but having two children with diabetes is so hard.


I am not certain as to how you were given a risk of "6.6 percent" chance of incidence in a sibling. I have not seen such a specific number quoted. I have seen data that indicates that a first degree relative, a sibling, parent, offspring, of someone with type 1 diabetes has about a 5 percent chance of developing diabetes. If they have measurable pancreatic antibodies, the chance may increase to near 50 percent, which is ten fold. But we have no preventative measure, so, that risk analysis may indeed not be really helpful, in practical terms. It may only serve to increase your vigilance. I, and I am certain my pediatric endocrine colleagues, have, unfortunately, seen many sibling pairs with type 1 diabetes.

Classic "type 1" diabetes is most often due to an immune system mediated process such that the body's own immune system develops proteins, antibodies that "attack" the pancreas, which are called "islets" (pronounced "I-lets"--little islands). Nearly 90-95 percent of cases of type 1 diabetes are due to this autoimmune process. Similarly related immune system issues can include thyroid disease, adrenal insufficiency, systemic lupus, rheumatoid arthritis, celiac disease and others.

There are other, much rarer, situations that can lead to pancreatic islet cell destruction. Some relate to more global pancreatic inflammation from toxins, e.g. alcohol, chemotherapies for certain types of cancer, trauma, etc. All cases of type 1 diabetes are prone to ketosis and the potentially fatal diabetic ketoacidosis (DKA).

Of late, there are more folks who tend to classify type 1a versus type 1b diabetes. The latter is essentially type 1 diabetes for which pancreatic antibodies have not been measured. This seems to be more prevalent in some specific ethnic groups, perhaps more often in African-Americans and Hispanics. Their absolute insulin requirement may not be as great as in typical autoimmune diabetes.

None of these are to be confused with diabetes in a patient with long-standing cystic fibrosis, another condition that can affect the pancreas.

I am not aware of any patient, anywhere, with bona fide autoimmune, type 1 diabetes, in whom insulin injections have been discontinued by diet and exercise alone. I have seen insulin doses decreased substantially with good attention to meals and activities, especially during the diabetes "honeymoon, " but not otherwise. I am aware of adults who have undergone pancreas or islet cell transplant, not yet a procedure done in children, who have been off insulin for a period of time.

You sound to be on the verge of being overwhelmed or maybe you are there already. For your sake and the children, you might wish to ask your pediatric endocrine and diabetes team to have you speak to their psychologist and psychosocial worker. There are support groups for adults and patients and families, education sessions, etc.


Additional comments from Brenda Hitchcock:

For more information type 1b diabetes, see Biomedical Science - Clinical Chemistry: Re-Classifying Diabetes and Can All Newly Diagnosed Subjects Without Type 1 Diabetes-Associated Autoimmune Markers Be Classified as Type 1b Diabetic Patients?


Original posting 14 Mar 2004
Posted to Genetics and Heredity and Other


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Last Updated: Tuesday April 06, 2010 15:09:56
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