I am having a bit of a problem understanding this diabetes thing. My 12 year old son has had diabetes for 10 years. A little over a year ago, my then two year old son asked to have his finger poked and his blood sugar was 327 mg/dl [18.2 mmol/L]. We called our son’s endocrinologist who told us to just check blood sugars four times a day for the next week, and during that time, we saw blood sugars from 35 mg/dl [1.9 mmol/L]all the way up to the low 300s mg/dl [16.7 mmol/L]. The endocrinologist did an antibody test which was positive so he started my two year old on Ultralente because he was too young to be entered into the trial and said it didn’t matter since he already had diabetes.

After several days, we discontinued the Ultralente because of low blood sugars, and his glycohemoglobins range from 6.5 to 6.9% (normal 4.8-7.8%) almost consistently. The lab says that is a “normal” value, while others have said this is clearly abnormal.

This whole thing makes me wonder, and I am uncertain of what to do. If my two year old has diabetes, why is he still experiencing lows? Without insulin? How can the glycohemoglobins remain in the “normal” range?

I believe that your two year old son does indeed have type�1A (autoimmune) diabetes; but some explanation of the lab results is indeed due. Random blood sugars of 300mg/dl [16.7 mmol] are clearly abnormal. Whilst: high blood sugars can sometimes be misleading in small children because of the stress effect, I think this is unlikely here because of repeated high levels associated with some low ones. There is perhaps some concern that these values were obtained by home glucose monitoring rather than a clinical laboratory; but again with ten years of experience this seems unlikely.

The low blood sugars can be explained by the fact that damaged beta cells may still secrete insulin, but there is a delay in the response so that the insulin reaches the blood stream after the glucose peak and thus may cause hypoglycemia. The timing of the low blood sugars in relation to meals should confirm this. Of course, the pattern wears off as the cell destruction becomes complete.

An upper level of 7.8% for hemoglobin glycohemoglobin is a little high in comparison to most methods, but in your son’s case I think that the high normal levels are a function of an average blood sugar that is in fact a mixture of values that are both too high and too low. This would show up if you downloaded the memory on his meter.

One final point that you might discuss with the endocrinologist would be to find out whether your son’s antibody test was a simple screening immunofluorescent test or whether he had the now more usual triple test for anti-GAD, anti-insulin, and ICA 512. If two or three of the latter were indeed positive then there would be no doubt of the diagnosis.

DOB