April 17, 2009
Hypoglycemia, LADA and MODY
Question from New Caledonia:
I discovered that my seven-year-old daughter suffered from hypoglycemia when she was two and a half. At the time, her blood glucose levels were from 75 mg/dl [4.2 mmol/L] to 85 mg/dl [4.7 mmol/L] in the morning and from 85 mg/dl [4.7 mmol/L] to 240 mg/dl [13.3 mmol/L] two hours after a meal. She went as low as 30 mg/dl [1.7 mmol/L]. We were told to put her on a diet. It worked for quite a number of years.
Since the start of 2009, she has had a number of hypoglycemic reactions again, so we started testing her. The past two weeks, she has been 95 mg/dl [5.3 mmol/L] to 117 mg/dl [6.5 mmol/L] in the morning and 110 mg/dl [6.1 mmol/L] to 180 mg/dl [10.0 mmol/L] two hours after meals. The only time we were able to test her after a hypoglycemic reaction was one hour after she had been given sugar for it and she was at 66 mg/dl [3.7 mmol/L]. Knowing that my father, grandmother, aunt and my husbands’ uncle all have type 2 diabetes, a friend suggested that we get her tested for MODY. Would it be worthwhile to do so?
Answer:
You should consult with a pediatric diabetes specialist to review these blood glucose readings. They are not hypoglycemic as you present them but there are several that are clearly hyperglycemic. It is essentially never normal to have values above 140 mg/dl [7.8 mmol/L] and certainly not 180 mg/dl [10.0 mmol/L] to 240 mg/dl [13.3 mmol/L] So, the question is what is the diagnosis? Maybe it is some sort of beta cell failure that is slowly occurring. Have standard antibody tests been done? Islet cell, GAD-65, IA2, etc. are commercially available while others are still in research mode. Whether or not it would be prudent to test for MODY genes would depend on lots of other clinical characteristics, A1c levels, etc. that should be discussed with the diabetes team.
SB
