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August 24, 2017

Diagnosis and Symptoms

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Question from United Kingdom:

I have type 1 diabetes; my dad has type 1 (LADA). I have two children, ages eight and 19 months. I occasionally check them because of the genetic link. Neither are exhibiting any symptoms currently.
It seems some foods cause my 19-month-old daughter to spike almost immediately before her sugars return to a normal level. Yesterday, she had a handful of grapes, which caused a high of 9.2 mmol/L [165 mg/dl] after about 45 minutes. Half an hour later, she was back at 4.9 mmol/L [88 mg/dl]. However, other foods like yoghurts, apples, and ice cream (we are on holiday at the moment so she has had the odd treat) seemingly don’t cause a problem. Fasting sugars are all between 4.5 mmol/L [80 mg/dl] and 5 mmol/L [90 mg/dl]. Two hour sugars have all been between 5 [90 mg/dl] and 5.8 mmol/L [105 mg/dl]. I am worried about these spikes. She is a very overweight child, despite having a healthy diet, as she has had too much milk. This is my fault as she was premature and I was worried about her gaining weight. Now, she needs to probably lose seven pounds to be a healthy weight. Could this cause these spikes? Or, is it the start of type 1? I’m driving myself crazy with worry. I’ve cut her milk back hugely and she is only having natural foods, mainly low sugar, mostly because I want her to lose some weight.

What are you thoughts? Should I just continue to watch and wait? Is it more likely to be the start of type 1? She seems to make the insulin, but with very fast acting foods, it isn’t quite fast enough.

Answer:

The weight is likely a contributor, but it is definitely not normal to spike, even if the spike is only occasional. The excess weight may contribute to what is called insulin resistance, so cutting back on carbohydrates and any excess calories, decreasing sedentary behavior, television, and computer time, while increasing activity daily will all help. Certainly, you should avoid grapes as one identified culprit. But, this indicates a potential for further insulin deficiency so I would recommend that you schedule an evaluation by a pediatric diabetes specialist (not your pediatric consultant). I’d recommend type 1 antibody testing to see if she already has positive antibodies and perhaps also an A1c test. Lipid and liver functions would also be interesting to know and the same for vitamin D blood levels. You might also want to bring a two or three day profile of before meal and one to two hour post-meal blood glucose levels to review with the specialist also.

SB