Our five year old son’s urine was positive for glucose during a routine kindergarten exam. Our pediatrician told us he likely had type 1 diabetes, and sent us directly to the hospital. His blood sugar was only 142 mg/dl [7.9 mmol/L], and the hemoglobin A1c came back normal. No antibody testing was done. Two subsequent urine tests were negative. Our pediatrician feels the mostly likely cause is a high intake of sugars resulting in a blood sugar over 160 mg/dl [8.9 mmol/L] which would then show up temporarily in the urine test. He recommends no further treatment unless other symptoms are manifested.

Isn’t it uncommon for the body not to produce enough insulin to keep blood sugar below 160 mg/dl [8.9 mmol/L]? Would it be prudent to get a test for antibodies to see if he is possibly in the beginning stages of type 1A diabetes and if positive, consider the use of nicotinamide to defer insulin dependence? Also, if his antibody tests were to come back negative, could type 1B be a consideration? Our son is adopted and of Latin American descent. We have no medical history for his parents.

Would you recommend getting the antibody test or a second opinion from a specialist? Is our pediatrician’s diagnosis reasonable and our son is likely diabetes free?

A single positive urine glucose test using a dipstick with a subsequent random blood sugar of only 140 mg/dl [7.8 mmol] and a normal hemoglobin A1c is certainly not diagnostic of diabetes, and I expect that the pediatrician will turn out to be right, especially as your son’s background is Hispanic. Nonetheless, this just could be a manifestation of a transient minor stress in a child in the pre-insulin dependent phase of type�1A (autoimmune) diabetes. A true fasting blood sugar would normally be quite enough to allay anxiety, but, in a five year old, an environment of doctors, needles, white coats, and an anxious mother can result in a falsely high reading. In the circumstances. I think that I might ask for an antibody test even if I had to pay for it. If you call 1-800-425-8361 which is the National Center for the DPT-1 trial, they might do a test without charge or you can get it run commercially by a laboratory.

The final answer on nicotinamide is not yet out, and the major European trial has another year to go. However, there was a smaller trial on New Zealand school children wherein about two thirds of the antibody positive children found on screening, insulin dependence could be deferred for up to six years.

If this test is done and comes back negative you’re quite right to suppose that he might have type�1B diabetes, but because this condition’s basis is so little understood and no studies have been done to see if insulin dependence can be delayed, I think it would be wise just to await events.

DOB