Two years ago, my now nine-year-old son passed out from low blood sugars. His sugars are unstable and he has had seizures from low blood sugars in the past. His pediatrician has classified him with type 1 diabetes and has not transferred him to a pediatric endocrinologist. His GAD came back 2.1 (normal less than 0.5) and his A1c was 5.4. His pediatrician said that this does not mean that he is an exact type 1, but that eventually he probably will be and will probably have to take insulin to level his blood sugar. He is scheduled for a fasting glucose exam now. Does this really make him a type 1 diabetic? Am I understanding this right? What do all these test tell me?

One cannot make a diagnosis of type 1 diabetes with only one positive antibody although this is suspicious that he is heading in that direction. It is better to test also for islet cell antibodies (ICAs), insulin antibodies (IAAs), and GAD-65 antibodies all together and then repeat these a few times to see if they persist or were transient. All this is very complex and I suggest you work with a pediatric endocrinology/diabetes team most likely. Prior to diabetes, there can be some erratic insulin release, which could explain the hypoglycemia that antedates the development of diabetes. There is also some research evidence suggesting that strict avoidance of simple carbohydrates and following a diabetes meal plan would save the damaged pancreas, by possibly helping slow down or possibly prevent the development of diabetes and a need for insulin. This has not been confirmed, however. So, eating three meals and three snacks with low glycemic index foods and always some protein/fat should help avoid the hypoglycemic events and should also require less insulin release for this high risk pancreas.

SB