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February 6, 2020

A1c (Glycohemoglobin, HgbA1c), Diagnosis and Symptoms

Question from Canton, Ohio, USA:

A few months ago, I requested an A1c test for my 18-month-old daughter because I suspected that she has diabetes. She is constantly thirsty and filling her diapers as soon as I change them, basically. She also has lost a couple pounds. Diabetes runs pretty heavy on my dad’s side; my grandfather and great grandfather, great uncle and great great uncle all died from DKA. I also had gestational diabetes when I was pregnant with her. Her A1c came back at 5.5. I continue to check her blood myself at very random times just to see what her blood sugars are doing. Her numbers typically range from 90 to 160 mg/dl [5.0 to 8.9 mmol/L]. With her A1c being this high at such a young age, they told me she was borderline pre-diabetic and that she would probably end up with diabetes sooner than later. Is this true? Is there anything I can do to prevent this?


From: Dr. Stuart Brink

You probably should get an appointment with a board certified pediatric endocrinologist specializing in diabetes. Dr Jamie Wood in Cleveland and Dr Robert Hoffman in Columbus are two colleagues I might recommend. But, someone who can do some specific antibody blood testing may help gather more specific risk information. An A1c of 5.5 is normal, however, with most laboratories normal range from about 4 to 6% so that is somewhat reassuring. But random blood sugar checks up to 160 mg/dl [8.9 mmol/L] is borderline-high. If there were definite weight loss, excess urination, difficulty breathing, acetone on breath, then those would need immediate evaluation with your PCP/pediatrician or ER and immediate blood glucose check. Antibodies, if positive, would suggest a higher risk of overt diabetes while negative results wouldn’t be so informative since the antibody tests are not 100%. Prevention trials are still in research mode but antibody tests should be next step. The pediatric diabetologists in your area should know what is available or be able to point you in the right direction.