Have you ever heard of a child being diagnosed with Type 1 diabetes who is not put on insulin injections immediately?
Once Type 1 diabetes is definitely diagnosed, insulin should be started soon as possible. There is a syndrome of transient hyperglycemia where individuals may have a transient high blood sugar usually associated with a viral illness or other infection, often in the low 200's, usually without ketones unless they are dehydrated from fever and vomiting from their illness. If the blood sugar normalizes in 24-48 hours, only about 25% of these individiuals will go on to develop true diabetes. The remainder will maintain normal blood sugars, though glucose tolerance testing may be abnormal for a few weeks, and then eventually normalizes.
In patients where you are not sure if they have true insulin dependent diabetes versus transient hyperglycemia, watchful waiting, with blood glucose testing and urine ketone testing, may be appropriate. In the meantime anti-islet cell and anti-insulin antibodies can be measured to help decide if this is true permanent diabetes, and the patient can learn the meal plan so if Insulin Dependent Diabetes is diagnosed, the patient will have an easier and shorter education period. Of course, if the blood sugar remains elevated, even if no ketones are present and the patient is asymptomatic, insulin should be started (as long as there is no reason to think the child has non-insulin dependent diabetes, which can occur in overweight teenagers with a strong family history of non-insulin dependent diabetes).
Original posting 13 Aug 96
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