February 16, 2001
Diagnosis and Symptoms
Question from Gaza, Israel:
Six months ago my seven year old son had a fasting blood of 263 mg/dl [14.6 mmol/L] and an A1c of 6.7% so his doctor put him on 6 units of insulin in the morning and 2 units in the evening. Since my son was having a lot of lows, his insulin was discontinued, and he is doing well. His A1cs have been 4.9% and 5.7%. He is eating everything, including chocolate, cakes, etc., and his blood sugar is in the normal range after two hours after meals. However, about once a month, not connected to eating, his blood sugar will be 200-290 mg/dl [11.1- 161.1 mmol/L]. Then, within about two hours it returns to the 80s [mg/dl, 4.4 mmol/L] and even to the 50s [mg/dl, 2.8 mmol/L] half an hour later. During this high, he doesn’t show any symptoms like urinating a lot or being thirsty. On the other hand, he sometimes has lows (50s – 60s [mg/dl, 2.8 – 3.3 mmol/L]), even two hours after a meal. For example, two days ago, he ate two large pieces of cake with his sandwich at school and then he had his lunch at home, and two hours after lunch, his blood sugar was 68 mg/dl [3.8 mmol/L]. Our doctor said that it could never be classic type 1 diabetes. My son isn’t complaining about anything, and his fasting blood sugar is always normal (60-100 mg/dl [3.3-5.6 mmol/L]). What is the problem with my son? Could it be type 2 diabetes? His two grandfathers have type 2 and his grandmother also has it, but my son is not fat.
Answer:
The initial blood sugar was abnormal and the hemoglobin A1c test was a little bit over the upper limit of normal so that I would guess that your son may have some underlying glucose intolerance. This kind of story is sometimes seen in the preclinical phase of type�1A (autoimmune) diabetes when some stress like a minor infection can raise blood sugars transiently, and at the same time, the insulin response to a glucose load can be abnormally delayed giving rise to what is called a rebound hyperglycemia. In any event, I think a consultation is in order. it would be sensible to ask for an antibody test, and you could also ask about the possibility of type�1B or type�2 diabetes. if your son is overweight and not very active, it is a possibility. Certainly, he seems to have a good appetite.
Another possibility is that he does have another form of reactive hypoglycemia which might be detected with a four-hour glucose tolerance test and then treated with dietary means.
DOB
