September 29, 2004
Question from Ann Arbor, Michigan, USA:
I have two daughters. My oldest is 18. She was diagnosed with Polycystic Ovary Syndrome (PCOS) when she was 13, after a large weight gain and cessation of periods. When she was 14, she was diagnosed with type 2 diabetes. Her results from a glucose tolerance test showed a blood glucose level of 185 mg/dl [10.3 mmol/L] after two hours. She was prescribed metformin, but could not take it due to extreme nausea. She lost weight working with a nutritionist and her blood glucoses are normal, as are her A1cs. My second daughter is 11. She recently went in for a routine check up and had glucose in her urine. Her random blood glucose was 165 mg/dl [9.2 mmol/L]. The doctor now tells me that she has type 2 diabetes. She is not overweight, in fact her weight is perfect. Yesterday, she wanted to check her blood on her sister's meter a half hour after drinking some pop. It was 160 mg/dl [8.9 mmol/L]. Two hours later, it was 97 mg/dl [5.4 mmol/L]. My second daughter's A1c was also normal. The doctor is concerned the diabetes will show up stronger after she begins menstruation. Since my oldest daughter's blood glucoses and A1cs are normal, does that mean that she still has or ever did have type 2 diabetes? If she gains weight, which she is doing again, will her blood glucose levels go up again? Is there anything more she should be doing besides diet and exercise? She doesn't check her blood often; should she be? Also, should I be concerned about my second daughter's blood sugar levels? Are they too high? Does this indicate diabetes for her as well? Could the A1c be normal and they could still have diabetes?
If diabetes is treated (weight loss, insulin, pills), then A1c levels and even random blood glucose levels can be normal. If blood glucose levels are elevated, then, by definition, this is diabetes. It sounds, from your description, that this is likely type 2 diabetes related to the metabolic syndrome complex: insulin resistance, polycystic ovaries, menstrual problems, obesity, acanthosis nigricans, hypertension, hyperlipidemia, high uric acid levels, fatty liver/steatosis. Any or all of these can occur together and often in other family members.
You should discuss all these questions with your diabetes team since they know the specifics of your daughter’s needs. They can decide with you how often monitoring is needed, what should be done with activity, food planning, other laboratory monitoring, etc. The key is often maintaining ideal body weight so that the pancreas can be allowed to provide sufficient insulin to keep things normal. This requires a combination of appropriate food and activity and this must be individualized. Whether or not oral hypoglycemic or insulin sensitizing agents are needed and whether or not insulin is needed will depend upon the success of reaching all these goals.