From Calgary, Alberta, Canada.:
My son is 18 years old and was diagnosed with diabetes about 5 months ago. Doctors are still not sure if it is type 1 or MODY (type 2). At the time of diagnosis, his blood glucose level was 21 mmol/L (378 mg/dl) (3 to 5 mmol/L [54 to 90 mg/dl] is normal, I understand. Previous to this diagnosis, he was found to have Hashimoto's thyroiditis (about a year ago )and is on Eltroxin. He is also taking 4 mg of Gluconorm (repaglinide [a pill for Type 2 diabetes]) three times a day with meals. His blood glucose levels now range between 3.5 and 5.5 mmol/L (63-99 mg/dl. How do we find out if it is MODY or if, as the doctors say it is, type 1 and this is just a "honeymoon" period? If there is insulin in his blood, does that indicate that his islet cells have not been destroyed and that he is insulin resistant? Could he be taking oral medication for the rest of his life or is insulin in the future?
In view of the fact that your son has already been diagnosed with Hashimoto's thyroiditis, it is probable that his diabetes is also of autoimmune origin. This aggregation of autoimmune disorders has been called the Autoimmune Polyendocrine Syndrome Type II; diabetes is often but not always a component and the thyroid is often involved too, less frequently there is an association with the celiac syndrome and more rarely with the gastric mucosa some kinds of baldness and fasciitis as well as adrenal insufficiency. He should talk to his doctor about getting an antibody test. A positive test would be confirmatory. The fact that he is being managed on repaglinide suggest that he may also have LADA (Late Autoimmune Diabetes in Adults). Type 2 diabetes may be complicated to diagnose specifically because it comprises a number of distinct disorders. In the most typical form there is usually no insulin dependance, a distinct family history, evidence of being overweight and a normal or high fasting insulin or C-peptide level.
MODY or Maturity Onset Diabetes in the Young is another component of the insulin in dependant antibody negative kinds of diabetes and there are at least five variants and many subvariants. These again are complex to diagnose and probably not worth the trouble because the aim of treatment is to keep blood sugars as close to normal as possible with whatever treatment works best. If your son does turn out to have Type 1A or autoimmune diabetes, there is a strong case for starting on insulin even though he is in the honeymoon period; but he would have to talk this over with the doctor.
Original posting 2 Aug 2000
Posted to Diagnosis and Symptoms
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Last Updated: Tuesday April 06, 2010 15:09:12
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