October 26, 1999
Medications: Pills for Diabetes
Question from San Clemente, California, USA:
I’m 12 years old. I’m 135 pounds. I like swimming, soccer, and other sports. I think I’m very healthy. Three years ago I went to the doctor to get a annual checkup. My doctor found out that I have high blood sugar. My Hemoglobin A1c has been as follows in these 3 years: 5.9, 7.1, 6.2, 6.5, 6.1, 6.3, 6.2, 6.3, 6.6, 6.4, and 6.7. I took my blood test twice a day. Before breakfast, the meter number is lowest at 99 and the highest is 135. The average number is 126 for breakfast. Most of the numbers are over 110. After two hours of my supper, the number is the lowest is 122 and the highest is 177.
I control my diet very well and I have nothing that contains sugar for a few years. I also exercise a lot everyday.
My pediatric endocrinologist told me to take medication called Prandin. My parents told me not to take the medication right know before asking the Diabetes Team. Will you please help? Please tell me if it’s okay to take the medication and if I start it do I have to take it for the rest of my life? Or can I just not take the medication? Or use just exercise and control the food I eat. Which one is the best way?
I imagine that your pediatric endocrinologist feels that you most likely have a kind of diabetes called MODY 2 or Maturity Onset Diabetes in the Young, Type 2. This would fit with the story of never having needed insulin and of blood sugars that are only modestly abnormal. The A1c levels also look as though they too are only just above the upper level of normal though that would have to be checked against the particular instrument used. So first of all, well done, you for having achieved this very good control. I notice by the way that you did not say what your height is; but your weight is on the 95 percentile which suggests that you might be somewhat overweight for your height and that might need attention.
Now, Prandin or repaglinide is a new blood sugar lowering drug that works by making insulin more available to the cells. It is short acting and can be given just before meals and the dose can be adapted to how big your appetite is. The point of trying it would be to produce even better control without much risk of hypoglycemia, to add some flexibility to what you eat, to diminish even further the risk of long term problems and perhaps to prolong the ability of your own islet cells to produce insulin. I think you and your family need to discuss all this with the doctor and also the possibility that another drug called metformin might be a better choice to begin with. The addition of one of these drugs is a logical suggestion and if it does not help you can always stop taking it.
Additional comments from Dr. Deeb:
I would suggest measuring serum insulin levels and then also consider using a different pill, metformin, if elevated. I presume all the antibodies have proved negative.
Additional Comments from Dr. Stuart Brink:
The best advice I could offer you is to ask these same questions to your pediatric endocrinologist since he or she knows you very well and should be able to answer them for you. In general, the key question is whether or not you have Type 1A or Type 2 diabetes. He or she may already know this by testing for insulin levels or C-peptide levels and also for islet cell antibodies as well as insulin and GAD antibodies. He or she would also know what to expect from the specific hemoglobin A1c assay since this is important information to use for interpreting your goals. It looks like your blood glucoses are a bit higher than we’d like them to be and that may be why he or she suggested Prandin. Other medications to consider include metformin as well as sulfonylureas. But go back with some more blood glucose testing before and after eating for three or four days and share this with the diabetes team you are using and ask these questions to get better answers.