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From Long Beach, California, USA:

My 2 1/2 year old son was diagnosed 3 months ago with Type 1 diabetes. His blood glucose level was 394 mg/dl with positive ketones when admitted to the hospital. Subsequent lab tests came back with him testing negative for islet cell antibodies and autoimmune antibodies. His thyroid tests showed borderline hypothyroidism which was not addressed nor was his high cholesterol level. He has cyst-like lumps in his neck behind and under his ears which do not go away. Is there anything else that our endocrinologist should be looking into aside from the diabetes diagnosis? We were and still are lacto-ovo vegetarians and he was consistently 95% in height and 75-90% weight until diagnosis.


I don't think that there is any doubt about the primary diagnosis of diabetes. However you should know that some cases of diabetes in childhood do not show the typical antibodies of autoimmune diabetes; I assume by the way that he was negative for at least three antibodies: i.e., anti-islet antibodies, anti-GAD antibodies and anti-insulin antibodies. It has recently been recognised that about 50% of Hispanic and African children do not have antibodies. In Caucasian children the figure is less than 10%. Just what kind of diabetes these children do have is being slowly worked out; but the techniques for doing this are not widely available and in any case their treatment is not significantly different from the autoimmune type. Some of these children especially where there is a strong family history have one of the four variants of Maturity Onset Diabetes of Youth (MODY). Others have what is called 'mitochondrial diabetes' and yet others may still have an autoimmune form of diabetes; but one that leads to a different spectrum of antibodies. A significant number of these children do not continue to need insulin and this would be something to keep asking your son's endocrinologist about.

Hypothyroidism is commonly related to diabetes as another autoimmune condition and the high cholesterol is almost certainly a reflection of this. of this. It is important to watch this carefully as it is easily treated and if neglected can interfere with growth.

You might also talk to your son's doctor about getting two other antibodies done for some additional related autoimmune conditions. These are anti-21 hydroxylase for adrenal insufficiency and anti glutamic acid transferase for celiac syndrome. Both uncommon; but probably important to be aware of the possibility.

As to the lumps behind the ear, I suspect these might be enlarged lymph glands that are secondary to repeated upper respiratory infections, especially otitis media.


Original posting 16 Dec 97


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