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October 27, 2001

Diagnosis and Symptoms

Question from Deerfield, Michigan, USA:

I am 30 year old with type 1 diabetes since age one and a half, and my three year old son (who has not been diagnosed with diabetes) has been ill so I checked a checked his blood sugar with a meter that had been recently calibrated, and it was 412 mg/dl [22.3 mmol/L]. My wife took him to the ER where his blood sugar an hour and a half later was 120 mg/dl [6.7 mmol/L], and the ER doctor claimed it was impossible for my son's blood sugar to have been so high. This ER doctor did not feel it was necessary to perform a full blood workup. Could my son's pancreas be going bad and working only sometimes?

Answer:

The chances of your son developing type 1A (autoimmune) are only a little over 5%, and a random blood sugar of 120 mg/dl [6.7 mmol/L] is perfectly normal. With a normal random blood sugar at the hospital, I think it unlikely that he in fact has clinical diabetes at this time.

At the same time, the other blood sugar of 412 mg/dl [22.3 mmol/L] is certainly abnormal. Whilst it might be due to stress perhaps compounded by some technical error, in view of the family history I think you should talk to his doctor about some further testing. The simplest of course would be to get a fasting blood sugar in a clinical laboratory. Even so, if he is in the preclinical stage of diabetes, blood sugar levels may be a rather erratic index of a problem. So to allay anxiety, I would ask for antibody testing and not just the immunofluorescent ICA test, but the now conventional triple of anti -GAD, ICA512, and anti-Insulin antibody.

DOB