January 28, 2006
Diagnosis and Symptoms, LADA and MODY
Question from New York, USA:
My five year old daughter had a non-fasting glucose test of 168 mg/dl [9.3 mmol/L] (our pediatrics office gives all children blood tests at the age of five). This was about one and a half to two hours after a breakfast that consisted of pancakes with syrup and two glasses of milk. The doctor was concerned and retested her. He did a fasting glucose test and it was 107 mg/dl [5.9 mmol/L]. The pediatrician did not like the result and sent us to a specialist. My daughter has no other signs of diabetes. She is in the 95th percentile of BMI.
We have been doing random tests on our daughter (twice a day) and they come in between 115 and 145 mg/dl [6.4 and 8.1 mmol/L]. She tested positive for GAD antibodies and negative for the islet antibodies (the third was not tested for as they ran out of blood).
There is a history of type 2 in my family. My levels have been elevated for years (110 to 125 mg/dl [6.1 to 6.9 mmol/L] fasting) and my father controlled his through diet and exercise.
At first, we thought she might be showing signs of MODY given the family history. With the GAD testing positive, the specialist said there is a 90 to 95% probability it will develop into type 1. The specialist said that if she consistently tests above 105 mg/dl [5.8 mmol/L] (fasting) and above 170 mg/dl [9.4 mmol/L] (non-fasting, two hours after a meal), we should talk about treatment.
Is MODY possible? Is it definitely the beginning of type 1? Could it be nothing, just borderline numbers?
Answer:
Unfortunately, this does not sound like MODY with positive antibodies. It is impossible to make any diagnosis via the Internet. Your biggest risk factors are the excess weight since this can damage an already genetically programmed beta cell in the pancreas and help produce earlier insulin deficiency either directly or indirectly. There should be serious consideration for cutting back food and snack portions, cutting down carbohydrates, especially simple sugars, and cutting back fats. Plus, you should consider increasing daily exercise and decreasing sedentary activities (television, telephone, video games, etc.) Weight loss is critical for future health and may even help postpone or prevent clinical diabetes. The blood sugar levels you describe are borderline and indicate some insulin deficiency or insulin resistance. Watch blood sugar levels, especially during growth spurts and with any illness since those are the likely times that the beta cell will fail. And, stay in close contact with your diabetes team as well as regular medical team.
SB
