January 15, 2009
Diagnosis and Symptoms
Question from Chula Vista, California, USA:
My daughter was hospitalized about a year ago because of high blood sugars. She had just turned two and was initially diagnosed with MODY because her body had corrected itself within a few hours without any medication, insulin, etc. About five doctors and two days later, the head of endocrinology at Children’s Hospital in San Diego took over her case and said there was no way she had any type of diabetes due to her A1c being 4.8 (which is actually too low). The doctor discharged her that day and chalked it up to a virus and has not seen her since. Since then, she has had about four high blood sugar readings, which we checked because my husband is a type 1 diabetic and has a glucose meter. All readings were in the 200s mg/dl [over 11.1 mmol/L]. Is it possible that she could be hypoglycemic or has a form of MODY? My father-in-law tested positive for the mutated gene that could cause MODY. Should she be seeing the endocrinologist annually to make sure she does or doesn’t have diabetes?
Answer:
Random high blood glucose readings certainly are not normal so it is difficult to know what type of glucose intolerance she has. MODY or some other genetic variants are possibilities as are other types of slow damage to the pancreatic beta cells themselves. Some are autoimmune. Some are different types. It would be reasonable to request specific genetic testing that is now available to see if this can be better defined. More importantly, it is also reasonable to limit excess sugar intake and especially simple carbohydrates since this may allow an intermittently working pancreas to work longer. With any illness, any change in urination, enuresis or thirst, it is also important to keep checking her blood sugar levels so that you know that there has not been a deterioration where insulin treatment would be needed.
SB
