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February 21, 2006

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Charlotte, North Carolina, USA

My six year old son is not overweight. His father was diagnosed with type 2 last year and I had gestational diabetes during both of my pregnancies. I have always had concern that the genetics would "get him." So, I just decided to test him one night, about 90 minutes after his meal, and his blood sugar was 280 mg/dl [15.6 mmol/L]. I was alarmed. His fasting remained elevated, between 90 and 100 mg/dl [5.0 and 5.6 mmol/L] but not diabetic. I contacted the pediatrician and they tested his urine. He had no ketones. They referred me to pediatric endocrinologist. They ran tests and his A1c was 5.6. He mentioned MODY but has yet to test for that. The blood tests for type 1 came back negative. All the doctors seem a little baffled. He was diagnosed with hyperglycemia, unknown cause. A visit to a dietitian has changed his diet to carbohydrate controlled and this has helped to keep the levels in normal range. Due to a lifelong problem with gastrointestinal problems, he saw a gastroenterologist and they are now wondering if he has celiac disease. He has always had lactose intolerance and multiple allergies, too. Is there any link between these symptoms? What should we do with him?

ANSWER:

It sounds like hyperglycemia is the correct diagnosis at the moment. He has some glucose intolerance, which is what this means, and the treatment is careful observation, periodic blood glucose monitoring and awareness that this could change to classical diabetes with growth, illness, etc. There are some newly available tests for MODY types of diabetes and one need not be overweight to have MODY. You are correct to be concerned about the genetic factors in your family, so, I would stay in close contact with your diabetes team. Also, there is no known association between food intolerance and allergies but, there is some genetic association with type 1 diabetes and celiac disease since both are autoimmune disorders and both are associated with specific HLA gene markers. SB