August 22, 2006
Diagnosis and Symptoms
Question from Huntsville, Alabama, USA:
My 11 year old daughter is very thin, 30th percentile for weight and 80th for height. I had noticed this summer that whenever she ate sugar, she got extremely nauseous and stayed this way for about an hour afterwards. My friend’s daughter has type 1 diabetes. While they were over swimming at our pool, I asked my friend to check my daughter’s blood sugar. I was shocked to see it was 217 mg/dl [12.1 mmol/L]. We had eaten about an hour and a half earlier. We waited another hour and rechecked; it was 130 mg/dl [7.2 mmol/L]. I called my pediatrician to run it by him and he wanted to see her that afternoon. When we got there, her blood sugar was normal and she had no ketones or sugar in her urine. He sent us home and had us continue to monitor her sugars. The next day she was 122 mg/dl [6.8 mmol/L] fasting and 196 mg/dl [10.9 mmol/L] after breakfast. I called him back and he immediately contacted a pediatric endocrinologist.
I took my daughter to the pediatric endocrinologist two days later. They did an oral glucose tolerance test which came back normal. So, in the meantime we are testing her only after fasting overnight. Her readings have been as follows 110 mg/dl [6.1 mmol/L], 115 mg/dl [6.4 mmol/L], 128 mg/dl [7.1 mmol/L], 120 mg/dl [6.7 mmol/L], 119 mg/dl [6.7 mmol/L], 113 mg/dl [6.3 mmol/L], 118 mg/dl [6.6 mmol/L] and 117 mg/dl [6.5 mmol/L]. The doctor said to call only if we had a couple of readings over 126 mg/dl [7.0 mmol/L] and, as you can see, we have only had one, but, from everything I’ve read, anything over 110 mg/dl [6.1 mmol/L] is a little too high.
Do you think it’s possible that this could be the early stages of type 1 and it will further progress with time? Or, do you think she could be on the road to type 2 even though she is very thin and active? Or, that this is absolutely nothing at all to worry about?
Answer:
You are correct to be concerned. Your pediatrician and the pediatric endocrinologist responded correctly and quickly. The values you report are definitely not normal, but they do not require medication or insulin at this moment. Whether or not this will progress is not so clear. Under such circumstances, it may be wise to get antibody tests such as islet cell and GAD-65 antibodies to see if there is already evidence of islet inflammation. If positive, this would portend eventual beta cell demise and need for insulin. If negative, this is not so helpful since antibodies are only positive about 60 to 80% of the time even in type 1 diabetes. Or, a negative set of antibodies could indicate type 2 diabetes, MODY, etc. There are some new genetic tests available, particularly if there is a strong family history of diabetes in several generations. I think that it is wise to continue to watch blood glucose levels closely and would encourage you to stay in contact with the diabetes team so that they can help you/them figure out what else might need to be done. Avoiding simple and concentrated sugar foods/drinks would certainly be prudent at this point as well.
SB