My seven year old son is going through some testing to determine if he actually had diabetes. Two years ago, he developed increased thirst and urination so his grandmother ( who has type 1 diabetes) did a fingerstick blood sugar which was 279 mg/dl [mmol/L], and his urine showed 3+ glucose and large ketones at his pediatrician’s office. Results of testing the next day were normal.

Since that time, he has exhibited symptoms of hypoglycemia occasionally but not hyperglycemia. However, about two weeks ago, he again started with some symptoms, and he had a fingerstick blood sugar in the high 200s mg/dl [11.1 mmol/L]. More tests revealed a serum glucose of 92 mg/dl [5.1 mmol/L], and an A1c of 4.8%, but he had positive islet cell antibodies which previously had been negative.

The pediatrician is confused by this, and unfortunately we are lacking a pediatric endocrinologist in this area presently. I am wondering if this means that my son will develop full-blown diabetes or if there could be some other reason for this. I realize that hypoglycemia can be considered a precursor to diabetes, but I am wondering if this is the case for my son.

You should consult with your pediatrician and most probably with a pediatric endocrinologist who has experience with diabetes. This sounds like a somewhat unusual example of a prolonged run-in to classical diabetes. I do not know how long this will last — sometimes it’s many years.

We see kids with hypoglycemia for some time and think this means the pancreas is slowly being damaged and eventually gets to the point where there is less insulin. In these early phases, the pancreas is acting like a bad thermostat that sometimes produces too much instead of too little insulin, thus the hypoglycemia.

We usually track such children with hemoglobin A1c values and especially are watchful during periods of growth spurts or illness since this is when the lack of insulin is likely to show up clinically. We usually monitor antibody levels, but this is more of a research than a clinical need since they are so expensive. The more positive the antibody levels and the more different antibody levels that are positive, the higher and sooner the chances of type�1 diabetes developing.

There is no known treatment to prolong this phase — only cutting back on concentrated sugars and making sure that the overall food balance is appropriate.

SB