My 3 year old daughter was recently diagnosed with diabetes. Her HbA1c was 17.2. Her hospital admission blood sugar was 900, but she was negative for ketones. How is this possible? Also, her thyroid antibody was above 314. but her T3, T4, and TSH [thyroid tests] were normal. What does this mean?

There is a spectrum in the metabolic response to insulin insufficiency. At one end, there are those who show severe ketosis, but only a modest elevation of blood sugar; and at the other end are people who have very high blood sugars of over 1000 mg/dl, but who are minimally ketotic. It would seem that your daughter was near the latter end.

Type�1A (autoimmune) diabetes is often associated with other autoimmune diseases the commonest of which is a form of hypothyroidism. The positive test for thyroid antibodies indicates that the autoimmune process has included both the insulin producing cells in the pancreas and the thyroid, a syndrome that is sometimes now called the Autoimmune Polyglandular Syndrome. Provided her growth and TSH levels are watched carefully and remain within normal limits her doctor may elect not to treat the thyroid issue; but if he/she does, it is a simple matter and the prognosis is excellent.

DOB