SA JOURNAL OF DIABETES & VASCULAR DISEASE REVIEW

References 10. Hattersley A, Bruining J, Shield J, Njolstad P, Donaghue KC. The diagnosis of and management of monogenic diabetes in children and adolescents. Pediat Diabetes 1. Neel J. Diabetes mellitus: a geneticist’s nightmare. In: Creutzfeldt W, Kobberling 2009; 10(suppl 12): 33–42. J, Neel JV, eds. The Genetics of Diabetes Mellitus. Berlin: Springer-Verlag, 1976: 11. Slingerland AS. Monogenic diabetes in children and adults: Challenges for 1–11. researcher, clinician and patient. Rev Endocr Metab Disord 2006; 7: 171–185. 2. Keen H. The genetics of diabetes: from nightmare to headache. Br Med J 1987; 12. Barrett TG. Differential diagnosis of type 1 diabetes: which genetic syndromes 294: 917–919. need to be considered? Pediat Diabetes 2007; 8(suppl 6): 15–23. 3. Rotter JI. The modes of inheritance of insulin-dependent diabetes mellitus or the 13. Clinical genetics and genetic counseling. In: Jorde LB, et al., eds. Medical genetics of IDDM, no longer a nightmare but still a headache. Am J Hum Genet Genetics, 2nd edn. St Louis: Mosby, 1999: 292. 1981; 33: 835–851. 14. The National Society of Genetic Counselor’s Task Force: Resta R, et al. A new 4. Craig ME, Hattersley A, Donaghue KC. Definition, epidemiology and classification definition of genetic counselling: National Society of Genetic Counselor’s Task of diabetes in children and adolescents. Pediat Diabetes 2009; 10(suppl 12): 3–12 Force report. J Genet Couns 2006; 15(2): 77–83. 5. Jahromi MM, Eisenbarth GS. Cellular and molecular pathogenesis of type 1A 15. Peng H, Hagopian W. Environmental factors in the development of type 1 diabetes. Cell Mol life Sci 2007; 64: 865–872. diabetes. Rev Endocr Metab Disord 2006; 7: 149–162. 6. Njølstad PR, Molven A, Groop L. Diabetes genetics: A seventh sense for the 16. Kishiyama CM, Chase HP, Barker JM. Prevention strategies for type 1 diabetes. successful sequel of ‘come together’. J Pancreas 2009: 10(4); 466–471. Rev Endocr Metab Disord 2006; 7: 215–224. 7. Concannon P, Rich SS, Nepom GT, Genetics of type 1 diabetes. N Engl J Med 17. Zhang D, Efendic S, Brismar K, Gu HF. Effects of MCF2L2, ADIPOQ and SOX2 2009; 360: 1646–1654. genetic polymorphisms on the development of nephropathy in type 1 diabetes. 8. Kantarova D, Buc M. Genetic susceptibility to type 1 diabetes mellitus in humans. BMC Med Genet 2010; 11: 116. Physiol Res 2007; 56: 255-266. 18. Möllsten A, Jorsal A, Lajer M, Vionnet N, Tarnow L. The V16A polymorphism in 9. Type 1 diabetes loci. Available at http://www.t1dbase.org/pages/regions (accessed SOD2 is associated with increased risk of diabetic nephropathy and cardiovascular on 14/01/2011). disease in type 1 diabetes. Diabetologia 2009; 52: 2590–2593.

Living with diabetes in the family iabetes affects all members of the family, fat diet and the twice-daily insulin injections. I Dnot just the individual suffering with the soon discovered that the easiest way to inject Biggles disease. Even when the patient is stable on him was to wait until he was eating and his medication, one tends to watch him like a hawk attention was diverted from what I was doing. for any uncharacteristic behaviour that could He then didn’t mind me gently lifting the skin indicate that something is amiss. Untreated on the back of his neck and giving him the sores could potentially become infected, leth- subcutaneous injection. He was an extremely argy could indicate hypoglycaemia, and lack of good patient. appetite any number of problems. And there is Blood sugar is monitored in animals in the the constant niggle at the back of one’s mind same way as in humans but because Biggles about possible long-term organ damage. was so stressed at the vet, this could have Having a diabetic in the home also tends affected his glucose reading. So a twice-yearly to put a dampener on one’s social life. Several fructosamine test was the easiest and least dis- years ago, one of my boys became diabetic and ruptive way to monitor his blood sugar levels. needed insulin twice a day at mealtimes – insu- The blood sample is done in the laboratory and lin glargine at 7 am and 7 pm. This meant if I the fructosamine value reflects the average had a dinner date, I could only leave home after glucose levels over the past fortnight. 7 pm. If I had an afternoon/evening function, This routine went on for three or more years I had to be back in time for the evening insu- until I gradually became aware that Biggles lin injection. Going away for a weekend was was becoming less active and more lethargic difficult because most house-sitters won’t give than he had been. One Sunday he was really insulin injections as part of their service. Once, subdued and seemed to be in pain, so I rushed when spending the weekend at a nearby hotel, him to the vet. On hearing that he was dia- eats normal cat food. He is doing very well and I rushed home at 7 am to give him the injection betic, the vet immediately tested his glucose has regained his sparkle and zest for life. There and then went back for a leisurely breakfast! levels and found them drastically low, border- is no obvious reason why his diabetes has dis- Type 2 diabetes seems to be relatively ing on a diabetic coma. appeared, but apparently this is a phenomenon common in cats and dogs and can be trig- A syringe of glucose administered orally that has been known to occur in cats particularly. gered by many things. In our case, it may have and an infusion of glucose pushed up his We of course are delighted that our boy been related to the stress of being trapped blood sugar levels, but by the next day, they is normal again. We no longer have to worry and put into an animal rescue organisation, had dropped way down again. The vet was about every cut or scratch becoming infected, together with the fact that Biggles had been baffled, so a battery of tests was ordered, but he doesn’t have to be kept calm, and the long- homeless for some time preceding this. Also, nothing else seemed to be amiss (except a bit term damage to kidneys and other organs of he was about 10 years old at the time of diag- of cervical arthritis). He was then taken off all the body is hopefully lessened. I am sure Big- nosis. The first indications were weight loss insulin and diabetic food and we monitored gles is also very pleased that we are no longer and increased drinking and urination, together his glucose levels daily. Fortunately they slowly using his neck as a pincushion, but otherwise with a dry, dull coat. rose over the next week and when we retested he seems oblivious to the worry and anxiety his Once Biggles was put onto insulin his con- six months later, the level was still within the disease has caused us. dition rapidly improved and we settled into a normal range. routine of a commercial high-protein, reduced Biggles is now off insulin completely and Shauna Germishuizen

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