Question from Tennessee, USA:

Our nine-year-old daughter was found to have elevated random glucose while having laboratory tests related to an autoimmune disorder. When the first A1c was done in April, it was 5.2. Her fasting glucose was 87 mg/dl [4.8 mmol/L] and her insulin level was 11.7. We met with a diabetes educator since the local pediatric endocrinologist will not be seeing her until December. She suggested limiting carbohydrates to approximately 45 grams per meals and checking her glucose each morning and after one meal each day. The laboratory tests were repeated in September. Her A1c was 5.5, fasting glucose 94 mg/dl [5.2 mmol/L], insulin level 5.7. Her home readings are usually higher in the morning than any other time and generally range from 100 mg/dl [5.6 mmol/L] to 115 mg/dl [6.4 mmol/L] with peak high and lows at 53 mg/dl [2.9 mmol/L] and 129 mg/dl [7.2 mmol/L]. Some after meal numbers are a bit high, but usually are between 100 mg/dl [5.6 mmol/L] and 120 mg/dl [6.7 mmol/L] with a 130 mg/dl [7.2 mmol/L] or 140 mg/dl [7.8 mmol/L] every now and then. Our pediatrician said he would order a glucose tolerance if we wanted to do it, but since it really won’t change anything, it seems pointless. Does this sound like she is moving toward diabetes or are we just worrying too much? Is a 0.3 increase in the A1c significant? Why would she have high fasting numbers but stay low the rest of the time?