November 30, 2010
Diagnosis and Symptoms, Honeymoon
Question from Carlsbad, California, USA:
My son has type 1, diagnosed at 19. My daughter’s son (my grandson, age 8) is suspected to be in his honeymoon. He sees a pediatrician in Carlsbad, California and is in clinical trials at CHOC (Children’s Hospital of Orange County). Also, he will soon be in gene testing through a doctor in Colorado. My grandson has not yet seen a pediatric endocrinologist. The blood results go to his pediatrician and to the UCI (University of California Irvine) Joslin Diabetes Center, as the Medical Director is a personal friend (doesn’t see patients under 18 usually). This honeymoon has lasted four years. My grandson is very tiny, short, and very, very thin. He is hungry all the time, even right after he is done with a meal. He eats an organic diet with little carbohydrates and lots of protein and vegetables. He has virtually little to no sugar in his diet and no milk. On November 24, his fasting blood sugar was 117 mg/dl [6.5 mmol/L](last time it was 67 [3.8 mmol/L]), his C-Peptide was 0.8 and his A1c was 6.7. The adult endocrinologist says not to do anything at this time other than monitor. They will be taking him to a pediatric endocrinologist soon. Everything that I read says that he should be on insulin to save the remaining islet or beta cells…not sure which. One last thing, he plays a lot of soccer and he runs real fast. Many times he holds his heart; when questioned, he says that his heart is beating hard and fast. What do you think?
Answer:
The A1c is too high and one of the two blood glucose levels you report is also abnormal. It could be a very early phase of type 1 diabetes or could be a variety of other types of diabetes, some called MODY, and may have genetic tests available. Also, antibody testing is available through research facilities and now also through commercial laboratories: islet cell, IA2 and GAD-65 antibody tests, if positive, would suggest this is autoimmune type 1 diabetes with an unusual prolonged presentation. His low carbohydrate food/snacks is a way of saving the beta cells also since they obviously do not have to work as hard. High exercise also helps. I am puzzled by the “heart pains.” This should be checked out with his pediatricians or with a cardiology consultation. I agree that this should be evaluated by a pediatric diabetologist and not a general pediatrician. Were he coming to see me, I would also ask you to do a “profile” of blood glucose levels for two or three days in a row: pre and one hour post breakfast, pre and one hour post lunch and pre and one hour post dinner to get a sense of how his blood sugar levels are running for a few days. Periodic A1c testing would also be good information to have sequentially.
SB
