January 12, 2023
Diagnosis and Symptoms
Question from New York, USA:
My daughter was diagnosed with a high sugar level in July during a routine bloodwork. Her A1C at the time was 8.8. She was admitted to the hospital and initially was diagnosed with T1D. She was given insulin therapy with Basaglar and NovoLog. Once we started the therapy, we noticed she ran low too often. I had to make her snack to raise her levels constantly. I know I was doing the insulin correctly because we have an entire team educating us on this from the endocrinologist’s office. Anyway, after a month we stopped insulin therapy and just used exercise and healthy diet to manage. My daughter is not overweight so I had to make sure she is in a healthy weight and not losing any weight.
Meanwhile, her type 1 antibodies tests all came negative. Her A1C after 3 months was 5.7. So, the endocrinologist said it may be Type 2 or MODY. Her MODY genetic test was negative. We did another antibody testing and, again, everything but insulin antibodies was negative. The endocrinologist said that’s normal after insulin therapy. We also did a OGTT and C-Peptide. Her OGTT fasting glucose was 98 mg/dl [5.5 mmol/L] but her 1 hour and 2 hour blood sugars were very high. Her fasting insulin was also high; C-peptide was normal.
At this point she is just being monitored with a Dexcom CGM, no medication. We are participating in another study to test more genetic mutations and waiting for that result. Her sugar level recently has been a bit higher than usual. She has been taking Albuterol and Flovent due to her mild asthma due to catching cold and flu.. Her 30-day average according to her Dexcom is 157 mg/dl [8.7 mmol/L]..
What type of diabetes do you suspect? Could it be related to puberty? By the way, she had her first period in May and got diagnosed in July.
According to pediatric endocrinologist Dr. Linda DiMeglio, you’ll really have to wait and see how her diabetes goes to determine what type she has. Some people have early type 1 diabetes and test negative for certain autoantibodies. She could also have type 2 diabetes. She said it’s great that you’re having the genetic testing done and monitoring her blood sugars carefully, and she also suggested looking at family history of autoimmune illnesses in case it helps figure out the diagnosis.