PLease could you comment on the following case :
Boy 04-08-2009 , parents both from Hong Kong (chinese) , intelligent , college education .
The boy was diagnosed diabetes mellitus march 2012 , no signs of keto acidosis , poly uria polydipsia discrete weight loss .
Glucose levels elevated above 13 mmol/l
He was treated with subcutaneous insulin.
Diagnostic: antibodies IA2 GAD and anti islets negative (march 2012 )
MODY 1,2,3 ,4 ,5 negative (Leiden Netherlands )
Parents treated the boy with subcutaneous insulin for a few months ; then they discontinued the treatment for religious reasons .
We tried to convince the chinese family to restart insulin therapy (also with interference by other Hong Kong People ) , in vain .
The family went to Hong Kong but came back recently.
Now the situation is as follows : the boy grows Length SD -2 , weight/height SD0 , development is according to age .
No dysmorfism , no other medical history .
In the evening he has blood sugars above 10 mmol/l , HbA1c 77 mmol/mol
6-05-2014 : 16:09 hr glucose 12,9 mmol/l ; insulin 7,5 mIU/l ; C-peptide 0,5 pmol/ml
Conclusion : diabetes mellitus after two years without insulin therapy no metabolic derangement .
Parents still refuse to give insulin , are very reluctant to do further investigations
Question : are we dealing with a monogenetic type of diabetes or is this a type 1 without antibodies and a very much prolonged honeymoon phase ?
My diagnostic question to you is the following : do you know any form of diabetes occuring in the chinese population that we can think of in this case ?
Yours sincerely ,
Jaap Kooijman paediatrician
Amphia Hospital Breda the netherlands