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DKWMom

Type 1 or 1.5?

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DKWMom

Curious if anyone has had a similar experience. Five weeks ago, My 13 year old son was having extreme prolonged thirst so I took him to GP

who checked his urine and she said sugar level was off the charts and referred us to an Endo. His A1C was 9.3. 

His IA-2 was very high at 3.87 which is typical for a T1 diagnosis. However, his GAD was 0.00.  His Endo said he was like a 1.5, and a bit

of a mystery at present. They put him on Lantus and Humalog with very frequent BG monitoring. One week later, the Endo added 500mg

of Metformin 2x a day.

 

5 weeks post diagnosis, he has started having very frequent low blood sugar, especially mid mornings. I found him close to unconscious on his

bedroom floor one day, although his BG was 195 only two hours prior. Since that episode, the endo has been reducing both his humolog ratio

and his nightly Lantus dose, to the point of only having 10 units of Lantus at night, with 1:60 insulin:carb ratio for Humalog. After seeing his most recent BG numbers,

they have told us to discontinue the Humalog until his BG #'s start to rise again. (He is usually right around 100 or lower, all of the time for the past couple of weeks).

 

I have been reading everything I can find but have not found any one else who has had this same experience. Could he be simply "honeymooning" or

could he actually be a Type 2? Which doesn't seem possible due to his IA-2 of 3.87.

 

Thoughts? 

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Uff Da

I don't pretend to be an expert except in my own case of type 1.5 diabetes, but it sure sounds like honeymooning to me. Type 2 doesn't seem likely with that IA-2. 

 

To my knowledge I never had a honeymoon. However, I had to starve myself and got down to a BMI of 17.1 while trying to keep my A1c under 7.0 during the first year and a half while my PCP treated me as a type 2 with meds that didn't really work. (I started out with an A1c of 11.5.) When I finally got referred to an endo who diagnosed me with LADA, he found I tested positive to both IA-2 and GAD65. 

 

From what I've read, the more different antibodies a person test positive to, the faster the diabetes seems to progress. As I understand it, most diabetics who are diagnosed as children tend to have a fast onset and test positive to several of the antibodies. 

 

Based upon my very limited experience, I'd say it sounds to me like your son's doctor is taking a very reasonable approach for the circumstances. Each diabetes situation is a bit different, and I think you'll just have to wait and see how your son's diabetes plays out.

 

Sometimes when a person is first put on insulin and lowers the carb content of the diet, it gives the pancreas a bit of a rest and the endogenous insulin is better able to handle the body's needs for a while. That might be why his needs for injected insulin have gone down. 

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DKWMom

Thank you so much, what you say makes a lot of sense. I know that no matter which diabetes "label" he ends up with, that the most important thing is to keep him healthy.  I am grateful for the short reprieve from the shots before every meal (we are still counting and recording all carbs and BG's), sen if only for a short time. There look to be some amazing advances in the technological products to help diabetics manage their good glucose.  

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Cora

My thoughts are that at his age, he is a typical type 1. T1.5 will typically have a much slower onset. And in both cases, some of the antibody tests can be negative. It's not 100% reliable. Sounds like a "normal" honeymoon period to me. Insulin requirements can go up and down for some time during the first 6 months or a year in kids.

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NoraWI

GADA is not the only antibody that can be present in a T1. There are several other. Your 12-year-old son is probably honeymooning with sporadically active beta cells releasing insulin in an unpredictable manner. The T1.5 (LADA) nomenclature is used primarily for adults who have had a slow progressing T1 autoimmune diabetes. T2 is caused by insulin resistance. I doubt highly that your son has T2 at age 12.

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