Which MS medication will work for me if I have Type 1 Diabetes

Question:
I'm 55 now, and was diagnosed with Type 1 diabetes at age 52 and then with RRMS at age 54. Despite the health issues I am generally in good health but am having trouble with my MS medication. I started with Tecfidera and my blood sugars went through the roof. Then I changed to Plegridy and blood sugars were fine by had intense fatique and flue like symptoms and after 6 months asked to change medication. I'm now on Copaxone which seemed fine at first but now blood sugars are on the rise. Is there another medication option that would keep my blood sugars in line and minimize relapses (I had two incidents in 2012/13 with numb face/nerve damage and double vision)

Answer:
Type 1 diabetes is considered an autoimmune condition that progressively or intermittently destroys insulin producing islet cells in the pancreas. It has recently been suggested that symptomatic diabetes can occur with less than 50% destruction of insulin producing cells. This may be particularly true in late onset Type 1 diabetes. This means that certain immune based therapies could either improve or worsen Type 1 diabetes by decreasing or accelerating destruction of insulin producing cells, respectively. We could hypothesize that fumarate (Tecfidera) based therapies somehow worsened your glucose control by accelerating injury to the pancreatic insulin producing cells or creating auto-antibodies against insulin. Theoretically, the same could be true of Copaxone. Interestingly we would have expected interferon therapy to cause similar problems if this were the case.

To be on the safe side, it may behoove you to use MS disease modifying therapies typically used to treat humoral immunity of B cell function. These therapies would include rituximab, mycophenolate or azathiprine; Of these therapies, rituximab and the soon to be approved Ocrelizumab are the most effective. I would definitely avoid the use of alemtuzumab (Lemtrada) because of the high risk of precipitating autoimmune conditions with this treatment.

Revere Kinkel MD
University of California San Diego