My son is five and will turn six in November. He has not been feeling well lately. He has had stomach aches and, one night, he got clammy and cold. We took him to the Emergency Room and his blood sugar was 141 mg/dl [7.8 mmol/L]. The doctor said that was normal. His father has had type 1 diabetes since he was four. His uncle has also been diabetic since he was two years old, and my father is diabetic. We know that was a little higher than it should be. When we tested him this morning, his fasting blood sugar was 85 mg/dl [4.7 mmol/L]. As soon as we fed him, it jumped anywhere from 141 mg/dl [7.9 mmol/L] to 167 mg/dl [9.3 mmol/L]. That is testing before eating and two hours afterwards. The doctor did an A1c. All the results said was it was “normal,” but he did not give a number. Should we take him to our local Children’s Hospital and have him checked out by an pediatric endocrinologist? If not, what else should I do?

You are correct. These numbers for glucose readings are moderately abnormal, so this could be the earliest form of diabetes. He should have a formal consultation with a pediatric diabetes expert and probably antibody tests (islet cell, GAD-65, IA2 are the ones that we do) to see if there already is evidence for islet cell autoimmunity or not. The tests are not 100% but, if positive, would tell you that diabetes will develop. If negative, they won’t be so good for prediction purposes. Staying away from simple sugars and high amounts of carbohydrates would be reasonable. Some also would advocate staying away from wheat/gluten products because of the association of celiac disease and type 1 diabetes. Avoiding obesity may also be critically important. Watch for signs and symptoms of hyperglycemia: excessive urination, excessive thirst, sudden enuresis, unexplained weight loss and check his blood sugars so that he does not get sick or develop ketoacidosis (DKA). But, most importantly, go get a consultation with a pediatric diabetes team.

SB