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Question:

From Pennsdale, Pennsylvania, USA:

I would like to know what the number is that the pancreas produces insulin. Also, if type 1 diabetes were caught really early, can it be treated with diet and not injections? My grandson's first symptoms were increased urination and thirst. He had been on Prednisone and he also takes medicine for allergies. Would that affect his blood sugar?

Answer:

There are several "types" of diabetes mellitus. For instance, one type is associated with pregnancy (not your grandson, obviously). Another is associated in the patient with known cystic fibrosis (again, probably not your grandson, given you did not mention this in your letter). There are some forms that are distinctly inherited and this can be assessed by a careful family history (as one might expect diabetes mellitus to be present in parents, grandparents, great-grandparents, etc.). BUT, the most common manifestations of diabetes mellitus are now called "type 1 diabetes" and "type 2 diabetes." These have been called different names in the past. Type 1 was called "juvenile onset diabetes" or "insulin-dependent diabetes" because most often it manifested in children and, without insulin, this form of diabetes mellitus develops a terrible consequence of severe dehydration, blood acid imbalances, ketone accumulation, loss of mental awareness and ultimately death. This is called "Diabetic KetoAcidosis (DKA)" so affected patients are 'dependent' on insulin to live. Type 2 diabetes use to be called "adult-onset diabetes" or "insulin-independent diabetes" because it more typically occurs in heavyset and/or middle-aged adults. These patients rarely developed "DKA" and sometimes could manage their glucose with diet and exercise alone. They do not commonly produce the ketones.

In type 1 diabetes, there is essentially the inability of the person's pancreas to make significant contributions of insulin, although early in the course, there is some ability retained. (This is called the "diabetes honeymoon.") In a large majority of patients with type 1 diabetes, the pancreas' ability to manufacture insulin is inhibited due to a process whereby the body's own immune system inflames and "attacks" the pancreas slowly over time. This is an "autoimmune process." In type 2 diabetes, typically, a robust ability to manufacture insulin is usually maintained, but the person's body is "resistant" to the effects of insulin. But, if they are heavy and lose weight, some of the ability to respond to insulin returns. It is now clear, that even in type 2 diabetes, ultimately the ability to produce insulin diminishes and many patients need some additional insulin.

The other forms of diabetes occur far less often than type 1 and type 2 diabetes. So, in your young grandson, the most likely type of diabetes is type 1. Yes, certain medications, such as prednisone, can contribute to elevated blood glucoses and can mimic or unmask diabetes mellitus. There are several blood tests that your grandson's doctors can do, such as measuring autoimmune antibody proteins in the child's blood, to confirm type 1 diabetes or even look for the rare forms, if necessary.

Regardless of the type of diabetes a person has, proper diet and exercise will remain essential components to keep blood sugars under control.

I hope this helps you. I would prepare myself that this is "typical type 1 diabetes" and the family learn as much as they can from the child's pediatric diabetes care team.

DS

DTQ-20100115113745
Original posting 9 Feb 2010
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:10:20
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