My six-year-old daughter was diagnosed with type 1 diabetes three weeks ago. Her laboratory results were: GAD-65, IA-2 and insulin antibodies IN RANGE; blood glucose 273 mg/dl [15.2 mmol/L]; T3 96. Presently, my daughter is on Lantus at bedtime, NovoLog three times a day. There is no history of diabetes in my family. My sister-in-law and my husband’s grandma have problems with their thyroid glands.

Do you recommend more studies? Are these results enough to diagnose type 1?

I think that probably there is more information that you didn’t give or don’t have. For instance, you did not mention any medical information as to your daughter’s signs and symptoms that implicate diabetes mellitus. Nevertheless, based on the information of a glucose (was this a serum test or a “fingerstick”?) value of 273 mg/dl [15.2 mmol/L] (was this fast measured in the morning before anything to eat or drink?) in a six-year old-child, then a diagnosis of type 1 diabetes is certainly a strong thing to consider! If there were urine tests that showed ketones (or a blood ketone test that was positive), this would lend more credibility to a diagnosis of type 1 diabetes.

The information that the pancreatic antibody tests (GAD-65, IA-2, insulin antibody) were “in range” either tells me that something is not being communicated well but, if, in fact, these results were not elevated, it does not exclude the possibility of type 1 diabetes. Pancreatic antibodies are very often positive in type 1 diabetes (70 to 90% from some literature), but they do not need to be present to diagnose type 1 diabetes. People often lose sight that diagnoses of type 1 diabetes were made for decades before the presence of pancreatic antibodies were even discovered. Some of the medical literature refers to “antibody negative type 1 diabetes” as “type 1b” diabetes.

The “T3 96” of which you refer probably means a measurement of one of the thyroid hormones (called “T3”) and the value of 96 (ng/dl) is not at all informative regarding a diagnosis of type 1 diabetes. Thyroid problems and diabetes mellitus often occur together, so your child’s doctor may want more blood test results regarding her thyroid function (if not already done – and they probably have. I am confident that a pediatric endocrinologist would not measure T3 as the sole assessment of thyroid function.)

Please continue to follow up with your pediatric endocrinologist.

DS