About six months ago, during a middle ear infection, my two year old grandson (who is in our care) developed excessive thirst and polyuria, and he had a blood glucose of 20.3 mmol/L [365 mg/dl] which subsequently returned to acceptable levels. He did lose 1.5 K in weight but has now regained this. He also has had three episodes of thrush at the tip of his penis. At times he seems to lack stamina, requires more sleep that usual and has episodes of profuse sweating, while at other times he seems well apart from having repeated ear, throat and chest infections requiring antibiotics.

For the last two months, his blood sugars have been 2.1-8.9 mmol/L [37.8-160 mg/dl] before meals, and we were told initially that he was had glucose intolerance. Then we were informed that he had type 1 diabetes, and the paediatrician wished to commence insulin immediately. Last week he was seen by a different paediatrician who wishes to carry out glucose tolerance testing and says he does not require insulin. He mentioned fructose intolerance but admitted this was ‘a shot in the dark’.

There is a strong family history of type 2 diabetes (three generations), but no type 1. What would be our best course of action to ensure our grandson gets the best care without being overexposed to tests?

I think that your grandson is in the preclinical phase of type�1A (autoimmune) diabetes and that he was temporarily pressed into overt diabetes by the stress of the ear infection. A glucose tolerance test is quite unnecessary, but he should have a hemoglobin A1c test as an index of how often his blood sugars have been abnormal and also an antibody test to confirm that this really is an autoimmune problem.

If these tests are positive, there is a case for starting insulin even if his fasting blood sugars are still often normal. If the antibody tests are positive, he should at some stage in the near future have a TSH test for hypothyroidism which is a commonly associated condition and also an antiglutamyl transferase test for celiac syndrome which occurs in about 8% of people with type�1 diabetes.

Hereditary fructose intolerance causes hypoglycemia, and not hyperglycemia. It is a very improbable diagnosis indeed.

DOB
Additional comments from Dr. Stuart Brink:

Take your grandson to see a pediatric diabetologist who can help figure this out since what you are describing is certainly not normal, but somewhat atypical.

SB
Additional comments from Dr. Kenneth Robertson:
As a minimum, he requires a haemoglobin A1c test and I agree with the
notion of a glucose tolerance test. I am confident that the services for
children in Aberdeen are excellent and you should have no concerns about
inappropriate investigation.

KJR