My 10- year-old daughter has two siblings with type 1 diabetes. She was tested through TrialNet for genes in 2009. All were negative. She recently had a normal high blood sugar of 196 mg/dl [10.9 mmol/L] after eating and wet the bed all of a sudden so I took her for a glucose test. Two hours later, her blood sugar was 98 [5.5 mmol/L] and her A1c was 5.3. Now, she has tested positive for the GAD-65 antibody. Do you think she definitely will become diabetic due to not having the gene and now having it. My endocrinolgist said there is no way to tell for sure, but we know what to look for, so keep an eye on her. Have you seen kids with GAD-65 who did not go on to contract type 1 diabetes?

The GAD-65 is an antibody that indicates inflammatory changes in the pancreas and is associated with type 1 autoimmune diabetes. If it were negative and then became positive – and stays positive – that would be a high risk situation for her developing diabetes. The higher the antibody, the more the risk. The more similar her genetic testing with her siblings who already have diabetes, of course, the higher the risk as well.

The single high blood glucose level is worrisome but could mean that her pancreas is beginning to fail but still has some function left. Eating lower carbohydrate levels may help preserve beta cell function. More daily activity and avoiding obesity may have the same effect. There is a lot of research to try to intervene at this point if it is inevitable but no definitive safe studies. Optimizing vitamin D levels, perhaps getting blood vitamin D to about 50 ng/ml, shows some promise and is safe to consider with your diabetes team. The same with making sure there are adequate antioxidants such as those that may be obtained in an adult Centrum A-zinc once-a-day.

Most important, perhaps, would be ongoing monitoring of her blood sugar levels to see if there are intermittent high blood sugars occurring even if ony transient and to learn if these are happening more frequently. And, of course, pay attention to the amount and frequency of daytime urination, thirst, weight and overnight urination/enuresis. If these were increasing, this would suggest higher sugar levels, too. If we cannot yet prevent such diabetes from fully developing, we can let you monitor so that she does not get a lot of symptoms and does not become dehydrated or ill, may avoid needing hospitalization if she needs insulin and have all of this recognized by blood sugarlevels, rising A1c and/or symptom changes.

SB