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Question:

From Plainview, New York, USA:

My 14 year old daughter was diagnosed with pre-diabetes (type 2) in October 2004. She started on Glucophage and a diet. She was doing amazing. All her blood sugars looked good and she was doing great. Then, she went to sleep away camp for the summer. Testing "sporadically," she had one test at 420 mg/dl [23.3 mmol/L], but went back down to normal. She stared to test four times a day and had at least one reading each day around 200 to 250 mg/dl [11.1 to 13.9 mmol/L]. Her endocrinologist said to bring her home and start her on insulin, Lantus, one unit per day. Now, she is stable and has normal blood sugars. Her A1c is 5.5, which is slightly higher than it had been, but still okay, with no markers. I understood this to mean that there was no evidence of an "attack" on her cells. Her C-peptide was down to 0.7 from 6.6 at her original diagnosis and 1.1 before camp.

The doctor says this is the honeymoon stage of type 1 caught extremely early. So, she is back at sleep away camp, monitoring, eating well, doing her insulin shot. Based upon this information, is she definitely type 1? Is this the correct course of action?

Answer:

I don't think I have enough real information here to make a call. But, almost regardless, the anti-pancreatic antibody "markers" are not so 100% predictable/reliable. Some sources indicate a 70 to 80% value; other sources suggest that near 90 to 95% of patients with type 1 diabetes have positive pancreatic antibodies.

Long before we had these antibody tests, we made the diagnosis of diabetes. True, perhaps we underappreciated type 2 in young people, not best wanting to believe a child had "adult-onset diabetes" (now type 2). This may also be where Maturity Onset Diabetes of the Young (MODY) created confusion also.

Is your daughter thin or overweight? Does she have ketones? The low C-peptide is very supportive of insulin deficiency, a characteristic of type 1 diabetes.

An intravenous or oral glucose tolerance test might be helpful, but I might argue "What's the point? What does it matter?" If the real question and thus important answer is to determine her "need" for injections of insulin, then I might pursue this and do testing for the forms of MODY. If the real question is how best to regulate her glucose readings, it seems you are already doing that.

DS

DTQ-20050729113956
Original posting 2 Aug 2005
Posted to Diagnosis and Symptoms and LADA and MODY

  
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Last Updated: Tuesday April 06, 2010 15:10:04
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