case ; question

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Jaap Kooijman
case ; question

Dear  colleague,

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