From Moscow, Russia:
We would be very grateful to you for your advice concerning my daughter's disease. Several months ago, she developed type 1 diabetes. She is 11.5 years old, 35 kg weight, 135 cm tall.
The unique feature of the diagnosis is that beta-cell antibodies are not present (Antibodies-GAD 65). During the past few months, numerous daily episodes of hypoglycemia were observed, that were determined by our doctor to be due to proinsulin. From scientific publications we have found out about use of sandostatin. We wonder if it might be applicable to use this medication in our case and if so by what means? Taking in an account the specifics of our case, which ways of curing would you recommend?
Sandostatin is a long acting analog of somatostatin which seems to have been used mainly in Europe both to contain the microvascular complications of diabetes and to increase the efficacy of insulin in type 1A diabetes. If this child had a negative anti-GAD antibody test it seems possible that she does not have autoimmune diabetes but type 1B in which case sandostatin would be inappropriate; but insulin might be required only for a time.
I wonder too if there aren't technical problems with the blood sugar assays because the values sometimes change inappropriately in response to rather small and erratically given doses of insulin.
Additional comments from Dr. Jim Lane:Several issues remain unclear. Was anti-GAD 65 the only antibody measured? It may be helpful to measure another islet cell antibodies before you conclude this is not autoimmune diabetes. Second, proinsulin measurement requires a very sensitive assay. Do you have access to this type of assay? Are you sure it is not cross-reacting with the insulin she is taking? Finally, somatostatin analogue is a potential treatment if there is autonomous insulin production. I am not sure that is happening in this case.
Original posting 31 Dec 2001
Posted to Daily Care
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