June 6, 2006
Research: Causes and Prevention
Question from Fairbanks, Alaska, USA:
My son was evaluated by a pediatric endocrinologist two years ago for possible early type 1 diabetes after a couple of elevated home glucose tests and an a1c of 5.5. My son is thin and very active. His OGTT results were: fasting – 88 mg/l [4.9 mmol/L]; one hour – 226 mg/dl [12.6 mmol/L]; and two hours – 141 mg/dl [7.8 mmol/L]. His insulin and C-Peptide were both slightly below normal. All antibody tests were negative.
The endocrinologist told us that the likelihood of his developing frank diabetes was low, but to test if he got sick or had any symptoms of diabetes. I have tested him very occasionally with a home glucose meter after meals and his blood sugar is almost always elevated (above 126 mg/dl [7.0 mmol/L]).
The reason I’m writing is that I just noticed an article linking diabetes with shock wave therapy for kidney stones, which my son had at the age of four; we found the high blood sugars about a year later. According to the article, this treatment can damage beta cells in the pancreas, which seems like a good explanation for my son’s abnormal readings. Have you had any children (or adults) whose hyperglycemia could be attributed to this mechanism? Does the beta cell dysfunction progress or stay at this current level? What would you suggest in terms of treatment or diet?
Answer:
Kidney stone treatment and subsequent damage to pancreas remains a theoretical possibility, but without much good research/literature. This sounds clinically like a borderline diabetes condition. Whether this is pre-diabetes or not would obviously depend upon future progression. I would recommend staying in periodic contact with the pediatric diabetes team and certainly being aware of symptoms, higher blood glucose readings with illness or growth spurts, etc. Periodic blood glucose monitoring during illness or growth would also be reasonable so that more severe symptoms would be recognized and treated early rather than waiting for more dangerous situations to develop unknowingly.
SB
