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February 13, 2019

Diagnosis and Symptoms, LADA and MODY

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Question from :

In January 2018, my daughter (one-year-old at the time) presented in the ER with a blood sugar of 36 mg/dl, and ketones in her blood. They gave her glucose via IV, and her blood sugar jumped to 200 mg/dl. She was fighting the flu, and was also dehydrated. We were referred to a pediatric endocrinologist/diabetes specialist who had us start testing her blood sugars with a monitor. Her a1c started at 5.7, went up over several months to 5.8, then 6.2. Then, it started going down to 6.0, then 5.8, then 5.6. During her testing, she had a couple more lows, and a few over 200 mg/dl blood sugars. All five antibodies were tested and were negative. She is small for her age; at her 2.5-year-old well visit, she was 34 inches and 23 pounds. She was in the ER again for lethargy last night. When I tested her blood sugar before going in, at first it was 135 mg/dl, but after drinking juice it went to 261 mg/dl. She had her urine tested and there was sugar and ketones in her urine. Her doctor does not think she has type 1 or type 2 diabetes. What could all of this mean?

Answer:

Certainly none of this is normal but it is also not classical type 1 diabetes. especially with antibody testing negative but you didn’t mention which specific antibodies they tested. The usual ones would be islet cell, IA2, GAD65 and Zinc Transporter 81. I wonder about a monogenic type diabetes picture that would require genetic testing that can be done free of charge at the Professor Hattersley site in Exeter, England, part of the ISPAD program, or here in the United States at places like Athena Diagnostics or at the Children’s Hospital of Philadelphia Monogenic Diabetes Center. You may want to discuss whether or not this has been considered and tested for with your pediatric endocrine team since there are specific treatment implications if your child has a MODY type diagnosis.