My daughter was curious about my husband’s diabetes meter and asked if I would check her. I did and I was a little concerned with the number. It was not really high, but it was not normal either. I wanted to keep an eye on things, so I would occasionally test her in the morning or two hours after eating. I would notice that the post meal numbers were higher than a normal post meal of 140 mg/dl [7.8 mmol/L] and that her fasting was normal or just above normal. I called her doctor and they ordered a fasting glucose and insulin level test. That morning before we went for the test I did check her with our meter, just to be sure that it was not to far off. When we got the results back, her glucose was 80 mg/dl [4.4 mmol/L], which I know is great, and her insulin levels were a little below normal at 5.6. I asked the doctor if the lower insulin level could be causing the post meal highs and they were not able to help me. They said they did not see enough patients with diabetes to know. To make a long story short, they told me to call a diabetes center we have here, but they would not talk to me because we are not patients. So, I am not sure what to make of these results. Is it possible that she has enough insulin to keep her fasting levels normal but not enough to help keep her post meals in the normal range? The post meal number that scared me the most was 171 mg/dl [9.5 mmol/L] after two hours. That just seems so high for a little girl.

You are correct that a 171 mg/dl [9.5 mmol/L] blood glucose level is too high. The random insulin and glucose levels that you got are not interpretable, however. I would suggest that you do a series of four days of immediate pre-meal blood glucoses and then one to two hours post-meal. This will let you “bracket” the meal and see what is going on. If this is early diabetes, then the pre-meal normal values of less than 100 mg/dl [5.6 mmol/L] may be all in the 90s mg/dl [5.0 to 5.5 mmol/L] and higher whereas the post-prandial values will be above 126 mg/dl [7.0 mmol/L] (or above 140 mg/dl [7.8 mmol/L]). When you have this information, you should likely consult with a pediatric diabetes team near you for further advice and get a formal consultation visit. The more the values are strictly normal, the less need to worry; the more abnormal, of course, the more that this could be the early stages of type 1 diabetes. Then, antibody tests and more blood glucoses would be the order of the day.

With one parent having type 1 diabetes, we think the current risk estimates are 3 to 6% for kids. Islet cell, GAD-65 and IA2 antibodies, if positive, would give obviously high risk; if all antibodies are negative, then there’s a lower risk. But, the antibody tests are only about 60 to 80% good as predictors, so being good observers and watching the blood glucoses is the way to go if there are no symptoms. If there are symptoms, such as excess thirst, excess urination, unexplained weight loss or belly aches, bed wetting, hypoglycemia, then this needs more urgent evaluation.

SB