My son has been showing signs of diabetes. He turned three on July 1.He is approximately 38 inches tall and weighs 27 pounds. He lost 4 to 5 pounds in the past 4 to 5 months. He has been showing signs for quite a while. I noticed a change in his behavior, frequent thirst and urination, a dark ring around his neck. I took him to the doctor after checking his blood sugar at home with a glucose meter. I did two fasting checks, first thing when he woke up (no food or drink, besides water) and the readings were 114 and 115 mg/dl [6.3 and 6.4 mmol/L]. When I did a random check, his blood sugar was 176 mg/dl [9.8 mmol/L]. So, I made an appointment; I had to see another doctor but he basically made me feel like it’s hard to decide if a child that young has diabetes and he ran the tests, I feel, just to make me feel better. His A1c was 5.7; his average blood sugar was 110 mg/dl [6.1 mmol/L] and he showed impaired fasting glucose. When the nurse called and told me the results, he said it was nothing to be alarmed about, that we would check again in a year. I then took him in for his three year well child appointment with his regular pediatrician who seemed totally concerned and wanted to do an A1c, all the testing again in a month. He also had elevated calcium. We went in for his A1c this morning and will have the follow-up on Saturday. Could he be pre-diabetic? How often should he be getting tested? Should I be worried? Should I be closely monitoring his diet? This will be his last appointment with this pediatrician because the doctor is moving. I would hate for this to get put on the back burner because he is in between pediatricians. I just need someone to give me advice on what I should do, what questions I should ask at his appointment.

Sorry, but I disagree with the advice that you have been given. A1c levels are good as an average but when diabetes is just beginning, they can be misleading. Fasting glucose values above 100 are abnormal but the ones you quote are just a slight abnormality. However, after-meal values of 176 mg/dl [9.8 mmol/L] are definitely abnormal and suggest that there is a problem, perhaps early diabetes developing. That might explain the excessive urination. Weight loss, unless purposeful for obesity treatment purposes, is virtually never normal in a toddler. So, I would suggest what I call a profile: pre-beakfast blood glucose and then 1 to 2 hours afterwards, pre-lunch blood glucose and then 1 to 2 hours afterwards and pre-dinner blood glucose and then 1 to 2 hours afterwards. If you do this for three days, you will have a terrific idea of what is going on with his blood glucose values. The more the pre meal values are above 100 mg/dl [5.6 mmol/L]], the more worrisome. The same can be said for the post-meal blood glucose values, which are worrisome if above 140 mg/dl [7.8 mmol/L]. If there were still some question, then he should be seen by a pediatric diabetologist who will probably run some antibody tests, islet cell, IA2 and GAD-65 antibodies (perhaps Zinc transporter 8, if available). If negative, this won’t help figure out what is going on because in 20 to 40% of the time with new diabetes, the antibody levels are negative; if positive, then there is already significant inflammation in the pancreas and more worrisome. The key is watching his weight, watching his urination and thirst so that he does not get sick, and getting in touch with a pediatric diabetologist who can assist you. Anybody can order the antibody test from a special laboratory but the pediatric diabetes folks will know how to interpret all of the blood glucose and antibody results better. You are correct to be concerned.

SB