My seven year old daughter was diagnosed a month ago as being pre-diabetic for type 1 by an endocrinologist. Having never heard the term pre-diabetic associated with type 1, I asked for more tests. Her islet cell antibodies and GAD antibodies were negative, but her C-peptide level was low. The endocrinologist has now suggested that she has MODY, but admits to being very confused by my daughter’s symptoms. Her fasting levels in the morning are usually between 80 and 95 mg/dl [4.4 and 5.3 mmol/L]. Twenty minutes after eating, her glucose levels spike to 220 to 280 mg/dl [12.2 to 15.6 mmol/L]. Within one hour, her levels go down to approximately 140 to 160 mg/dl [7.8 to 8.9 mmol/L] and are back down to 90 to 120 mg/dl [5.0 to 6.7 mmol/L] within two hours, only to repeat again after eating her next meal. Her A1c was 4.7 and she is very, very thin and athletic, 53 inches tall and 55 pounds. We detected a trace of ketones in her urine on one occasion as well. Does this sound like it could be MODY? Or is it perhaps early type 1 even though the antibodies are negative?

Antibody tests are only positive about 60 to 80% of the time, so, this could just be early diabetes. If she is not obese, it could be MODY, but not likely without positive family history. There are some newly available special genetic tests that could be of help via Athena Diagnostics and also via Esoterix. However, we do not have a lot of experience in how to interpret these results yet. Time will help you. We would usually treat such glucose abnormalities as early diabetes and limit simple carbohydrates while maximizing daily exercise and continuing frequent blood glucose monitoring to see if the blood glucose abnormalities stay the same, improve or change. If they persisted, we might use one of several “diabetes pills” just like in type 2 adult diabetes patients to try to get better insulin function from what appears to be a damaged pancreatic “thermostat.” The goal should be to keep the pre-food blood glucose levels normal and prevent the high spikes after food, so, there are several options to combat such insulin resistance. There are several medications also known to cause such problems and, if she is using one of these, perhaps they could be discontinued or changed. If this is early type 1 diabetes, then time will help sort this out as well.

SB