My three year old son is slightly overweight (40 pounds), and I was concerned about his having diabetes, so I tested him with my glucose meter, and he had fasting glucose levels of 128-157 mg/dl [7.1-8.7 mmol/L]. His pediatrician ordered a fasting glucose test which was 114 mg/dl [6.3 mmol/L] (normal according to the lab). I’ve occasionally tested my son’s urine, which has been normal.The pediatrician’s reaction is to continue to test his urine, but otherwise to just watch my son. He already gets lots of exercise, and is on a relatively health diet. My endocrinologist has suggested that my son be tested for MODY glucokinase, since I, my mother, my mother’s sister, two of my mother’s sister’s children, and my maternal grandmother all have type 2 diabetes.

My son hates having his blood tested (and will no longer let me use my meter to test him), so I am reluctant to have him worked up unnecessarily. On the other hand, I don’t want to ignore something that should be treated aggressively now. Do you recommend that I bring him to a pediatric endocrinologist for further testing? Should I just let sleeping dogs lie, and wait until he’s a little older before he is subjected to lots of blood tests? Alternatively, can I be tested for MODY? (If the latter, do you have suggestions where I can be tested? My endocrinologist is under the impression that the only diagnostic testing for MODY that is currently being done is in the UK.)

These sound like very abnormal blood glucose readings. If your son is overweight, then he needs to lose weight with a combination of exercising more, turning off the television and eating fewer calories. If you need help, you should get a referral to a pediatric endocrinologist who understands obesity and ways to prevent or slowdown the advent of diabetes. These are all borderline blood glucose values and weight loss in a safe and prolonged fashion to change the style of eating etc is the treatment you will need for your son to prevent development of frank diabetes.

A consultation with a dietitian who understands the current epidemic of childhood obesity and type 2 diabetes in children would also be very helpful. There are several other tests that pediatric diabetologists might consider but it is difficult to provide specific advice to you without a full consultation, exam etc. (For instance, hemoglobin A1c, insulin levels, pancreatic antibody determinations, fasting lipids, thyroid functions, etc.).

SB

[Editor’s comment: According to the American Diabetes Association Classification and Diagnosis of Diabetes Guidelines, the fasting blood sugars you report (including the one done at the doctor’s office) are consistent with impaired glucose tolerance or what is now known as prediabetes. In light of this, I suggest you seek a referral to a pediatric diabetes team to assist with proper diagnosis and treatment. Also see What You Need to Know about Type 2 Diabetes in Children.

If you are not currently using a meter that allows for alternate site testing (AST), I suggest you purchase one. AST is essentially painless and your son may cooperate better.

SS]