My 17 year old daughter was diagnosed with MODY 2 a year ago. Lately her blood sugar numbers have risen to where they are 150 upon waking and around 200 before retiring. I have her on a 1500 calorie diet plan that I got from my dietitian. (I am Type�2, diagnosed about a year and a half ago. I have excellent control; last hemoglobin A1c was 5.6%). My daughter’s last A1c was 5.2% and we are now waiting for the results of the one taken a week ago.

Her doctor recently changed her medication from Glucotrol XL [a brand-name long-acting form of a sulfonylurea called glipizide] to glipizide. We have only seen moderate reduction in numbers, but he did warn us it could take 3 weeks to see better control. It has been 7 days.

It’s difficult to comment except in generalities. Several questions need to be answered, however:

Were islet cell antibodies and GAD antibodies checked. If positive, this is Type�1 and not Type 2 diabetes.

Were insulin levels checked? Most Type�1A diabetes would have negligible insulin or C-peptide levels.

What type of type 2 diabetes is this? Insulin resistance would best be treated with a medication like metformin [Glucophage, a different pill for Type 2 diabetes]. The thiazolidinedione medications like troglitazone (Rezulin), rosiglitazone (Avandia) and pioglitazone (Actos) are all promising but have worrisome liver toxicity and liver failure so I would be extremely reluctant to use them in young patients without many years more experience. Metformin, however, looks very safe and well tolerated with excellent results.

I would recommend that all these questions be posed to the primary doctor providing care for the diabetes and, ideally, to a pediatric endocrinologist with experience dealing with these issues. They are very important questions and should be answered on a very individualized basis.

We make all our recommendations based upon a blood glucose profile: premeals and 1-2 hours postprandial for 2-3 days and then address the pattern we see. Sometimes using bedtime NPH if there is very high fasting blood glucose values but okay blood glucoses rest of the day. Sometimes with sulfonylureas or Prandin-type [acarbose] medications and sometimes just with metformin. Weight loss and aerobic exercise lasting more than 45 minutes each day is the very critical aspect of treatment but also the most difficult to sustain.

SB