September 21, 2008
A1c (Glycohemoglobin, HgbA1c), LADA and MODY
Question from Georgia, USA:
My 12-year-old son had a genetic test through Athena Laboratory which confirmed that he has the dominant gene for MODY 2. Since the doctors are not very familiar with this and told me they would read up on it, I have a few questions. My son’s fasting blood sugar is usually around 120 mg/dl [6.7 mmol/L]. Before his MODY 2 diagnosis, I tested him at 2:00 a.m. five times and he was 134 mg/dl [7.4 mmol/L], 141 mg/dl [7.8 mmol/L] (twice), 137 mg/dl [7.6 mmol/L], and 133 mg/dl [7.4 mmol/L]. I have been able to keep his two hour after meal levels under 140 mg/dl [7.8 mmol/L] except for lunchtime, which is usually in the 145 mg/dl [8.1 mmol/L] to 155 mg/dl [8.6 mmol/L] range. He eats around 30 to 40 grams of carbohydrates at his meals. I am most concerned about the fasting number in the 120s mg/dl [6.7 mmol/L to 7.1 mmol/L] and his 2:00 a.m. numbers. My goal, of course, is to prevent long term complications. I have read that there is nothing that can be done about the high fasting numbers, but I don’t know how old these articles are. Can you provide any names of medications that can help with fasting and nighttime levels for MODY 2? Do you feel that we could do better with after meal levels or are these numbers in range of where we should be? Where should his A1c level be? Before the MODY diagnosis, it was 6.6 and 6.5. We have another appointment next month to check the A1c level again. We are being seen by a team of children’s diabetes endocrinologists but they do not have any other MODY 2 patients. Since my son has always been symptom free except for some mild fatigue and I don’t know how long he has been suffering high glucose levels, I want to do all I can to prevent any future complications for my son.
Answer:
It is most important to do ongoing blood glucose monitoring before and after meals to answer such questions. An A1c in the 6% range indicates frequent blood glucose values in the 100s mg/dl [5.6 to 11.0 mmol/L], just as you have indicated, and this poses some potential long term complications like all others with type 2 diabetes. MODY is a genetic variant. Avoiding obesity so that there is less body fat is important. This means trying to ensure at least one hour of solid, fat burning activity each day to allow optimal insulin utilization by the body. Staying away from simple carbohydrates and avoiding excessive amounts of carbohydrates would also be important. You should work closely with your diabetes team to see if there is any reason to consider any of the oral hypoglycemic agents used in other forms of type 2 diabetes, to monitor lipids and A1c levels and to decide how often glucose levels should be monitored at home as well.
SB
