After becoming suspicious of an acetone-like breath, I tested my three year old son’s blood sugar after a cup of juice. It read 319 at the one hour mark, then 222 at the two hour mark. He has subsequently seen a pediatric endocrinologist, and due to a positive antibody test (they tested for all three; one is positive, and we are awaiting test results on the third) as well as periodic high blood sugars (170-180 after a cup of juice), fatigue, etc., we believe that he is in a “pre-diabetic” state.

According to the doctor’s instructions, I test his blood sugars regularly at home. My meter has been tested by the hospital and has been found to be very accurate. His blood sugar is often low (i.e. 52 this morning upon waking, making him very sluggish and limp), and upon drinking juice it jumps quite drastically (239 at the one hour mark this morning after juice). It has only been this high one other time. However, if he does not have sugar, he tolerates food quite well, with readings either normal, or only slightly above normal (i.e. 135) one hour after eating. My father (diagnosed at age 6), my sister, my dad’s brother, and one other uncle all have Type 1 diabetes. I am very familiar with the disease.

As we believe, along with the endocrinologist, that my son is still in the pre-diabetic stage, where can we go to have him try nicotinamide? I am aware that while it has not helped those diagnosed with clinical diabetes, it has been shown to help stave off diabetes in pre-diabetics.

I quite agree that your three year old son has Type�1A (autoimmune) diabetes and with that rather formidable family history I think that there is a strong case for not awaiting events. There are several possibilities. The first, if he stays with only one positive antibody would be to just watch him closely because he could still go for a number of years without becoming insulin dependent, as part of this approach it might be worth doing insulin levels after an intravenous glucose tolerance test. This would tell you how close to needing extra insulin he was. But if he were my grandson I don’t think I’d want to subject him to that!

In any case the blood sugars so far suggest that the delay will not be a long one.The second might be to contact the national DPT-1 trial to see if he might be eligible for the oral insulin trial: the effect of insulin here is as an antigen and is not to control blood sugars. Again, if he was accepted and he may be too young to participate, the amount of monitoring along the road may be rather a burden at his age.

Last, but not least comes nicotinamide. I’m sure its not feasible to go to New Zealand or Britain so I should try to enlist the complicity of his endocrinologist. Nicotinamide is available without prescription as a ‘food supplement’ in any supermarket; but it would be wise to try to get the higher concentration slow release tablets which would make it easier to reach the 25mg/Kg/day dose.

DOB
Additional comments from Lois Schmidt Finney, diabetes dietitian:

Being 3 years of age does qualify this boy for the DPT study, but he may be already too far into the pre-diabetes state and so not qualify. I am concerned about recommending nicotinamide since there are side effects and it is not proven. I guess I would see if he can qualify for the DPT-1 and if not, closely watch for symptoms and do blood glucose readings every few days.

LSF