From Boise, Idaho, USA:
About six months ago, my now four-year-old grandson started to have excessive thirst and excessive urination. He was lethargic and wanted to be held all the time. Part Hispanic, he has stopped gaining weight. He is about 34 pounds, 40 inches tall. He was this same weight last year at his third birthday. He is at the 25th percentile for height and weight, down from a previous 50 to 75% percentile for both. Approximately two and a half months ago, I tested his glucose with a finger stick about three hours postprandial. His glucose was 300 mg/dl [16.7 mmol/L]. Three hours later, it was 132 mg/dl [7.3 mmol/L]. He was very lethargic and clingy and urinating constantly all day. We checked a fasting glucose the following morning and it was 60 mg/dl [3.3 mmol/L]. We took him for blood work. His A1c was 5.5. We did an IGA, TTG and Endomysial Ab for possible celiac disease due to his anemia and slow growth. He is at 25% for his height and weight where before he was at 50 to 75% for both. The IgA,Qn -38 (27-195), TTG - 1 (0-5) and Endomysial Ab were negative. He had large ketones and protein in his urine. Since then, we have put him on a diabetic diet. We rechecked his A1c two months later and it was 5.7; his fasting glucose was 77 mg/dl [4.3 mmol/L]. We also did a C-Peptide level, which was low at 0.9 with a normal laboratory range of 1.1 to 4.4 and fasting insulin of 2.5. Both type 1 and type 2 diabetes run really high in both families. At this point, is there a reason to be concerned? Is it worth it to see a endocrinologist or should we just keep up the diet and repeating the A1c levels every three months? His symptoms have gotten a lot better and only recur when he is with his father who does not believe there is anything wrong with him and feeds him a regular diet.
This could all be the beginning of diabetes but the slow height gain is not so typical. Weight loss with excess urination obviously could indicate hyperglycemia/diabetes. Normal A1c and normal glucose levels except for the random high value are probably okay, but in the beginning of the pancreas failing to produce insulin, there could be intermittent hyperglycemia. So, you could be treating his diabetes with carbohydrate restriction correctly. It would be important to know about the islet cell, IA2 and GAD-65 antibody levels since, if these were positive, then this would confirm very early autoimmune type 1A diabetes. If negative, this information is not very helpful since the tests will miss about 20 to 30% of those with type 1A diabetes, especially in kids less than five years old. I would maintain relative sugar restriction but not caloric restriction and watch the glucose levels if this were my patient and would track the A1c levels as well as review glucose monitoring. It is very important during a growth spurt or obvious illness of any kind to check glucose levels also so that if this were diabetes and those were the precipitating factors, he would not get sick or dehydrated. In a research setting, one might also check genetic markers to see if he has the same high risk genetic factors that predispose to type 1A diabetes.
Separately, it is important to find out why growth is not progressing normally. Celiac testing important. Also, perhaps some other testing is needed. This could also be answered during a pediatric endocrinology consultation.
Original posting 7 Jun 2010
Posted to Diagnosis and Symptoms
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Last Updated: Monday June 07, 2010 16:46:20
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