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June 27, 2002

Diagnosis and Symptoms

Question from South Point, Ohio, USA:

I have type 1 diabetes, and recently, while sitting around the dinner table, my children and wife wanted to test their blood sugars, and my eight year old son was 138 mg/dl [7.7 mmol/L]. I was surprised to see someone without the disease test this high. I tried it again to validate the reading, and it was again 138 mg/dl [7.7 mmol/L]. All the rest of my family members (including me) tested normal. Being paranoid, I tested him 45 minutes later and his sugar was 96 mg/dl [5.3 mmol/L]. I checked your website and it said do a fasting test, which was 90 mg/dl [5 mmol/L] the next morning. I watch for signs and have noticed that my son's appetite has increased, but he is also growing (which happens to eight year olds). Since we were eating dinner when he tested 138 mg/dl [7.7 mmol/L], and meters do have a certain percentage of error, what are the chances he has begun the process of losing his islet cells and it is taking his body longer to level his blood sugar ? What steps should I take next, if any, to see if he is catching this awful disease ? Should I be worried at all? Several doctors have commented several different ways. I'm going to pose this question to my doctors as well but I would love the benefit of your collective experiences.


Your concern is very understandable. A “random” glucose of 138 mg/dl [7.7 mmol/L] in an asymptomatic person is probably not worrisome. See Classification and Diagnosis of Diabetes.

In broad terms, there is about a 5% chance for any first degree relative of someone with type 1 diabetes to develop type 1 themselves. A recent paper gives different odds relative to the age of onset of that primary case.

If that first degree relative has antibodies against the insulin producing cells of the pancreas (islet cell antibodies, insulin autoantibodies, and GAD 65 antibodies), the risk may increase about 10-fold. If we had a good way to prevent diabetes in someone at known risk, then that information of first degree relatives may be helpful, but unfortunately, the DPT-1 trials have not been as successful as hoped.

Nevertheless, it may be helpful to know your child’s relative risk, recognizing that having pancreatic antibodies is not the same as developing diabetes. So, ask your child’s doctor if he/she will be willing to draw blood for ICA512/IA2, GAD65, and insulin autoantibodies. However, be certain that they go to a reliable lab that measures these antibodies frequently.


[Editor’s comment: Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal.

Another test, the glycosylated hemoglobin, might be used to help confirm a suspected diagnosis of diabetes, but the GHB (also called HbA1c or A1c) is not usually considered as appropriate to make an initial diagnosis. Antibody testing, as mentioned by Dr. Schwartz, can be done as a screening test in high-risk situations, or as confirmatory of type 1A (autoimmune) diabetes, but is not part of routine testing.

Home glucose testing, as in this case, might show elevated values, which would make the situation more urgent to get lab testing done to confirm the abnormal results. However, home glucose testing, if negative, would not exclude diabetes.