My 24 year old son had a marginally elevated fasting glucose on a routine physical and failed a subsequent two-hour glucose tolerance test. His fasting glucose is generally 118-132 mg/dl [6.6-7.3 mmol/L], and his two-hour postprandials have always been normal.. The endocrinologist feels he was picked up extremely early, as he does not have any of the normal symptoms. I do not understand why this pattern exists. Should he test glucose levels at night to see if he’s hypoglycemic and the liver is releasing glucagon?

Your son’s story is rather common among people who have type 1, especially when it’s diagnosed early. This is called the honeymoon which lasts only a limited period of time (generally longer in young adults than in children) and during which fasting blood sugar is always higher than normal, especially if you stop insulin treatment.

Subclinical nocturnal hypoglycemia is extremely unlikely if his therapy is diet and exercise only whilst glucose (and not glucagon) is normally released by his liver (gluconeogenesis) and affects the fasting blood sugar. The only way to keep also this under better control would be again insulin treatment. Ask your son’s doctor for further help.

MS