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October 24, 1999

Diagnosis and Symptoms

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Question from Minot, North Dakota, USA:

My 7 year old daughter has Type 1 diabetes, diagnosed 2 years ago. I also have a 2 year old son. At random, we checked my son’s blood sugar one evening before supper and were extremely alarmed to have his reading be 286. I was extremely distraught and contacted our physician who suggested we check his blood sugar again in the morning, which we did and the reading was 71. We have since tested with a reading of 111. I am extremely frightened to recheck it again and the only explanation we can come up with is that he didn’t have “clean” fingers at the time. Would you feel it is safe to say for now that he does not have diabetes or would you suggest an antibody test (or whichever test it is that determines a sibling’s risk for diabetes)? If so, if the antibody test is negative, are we assured that he will not develop diabetes and if it is positive, is it certain that he will?

Answer:

From: DTeam Staff

I would indeed suggest an Islet Cell Antibody test through the DPT-1 (Diabetes Prevention Trial Type 1). If the antibody test is positive however, your son can not be enrolled in the trial until he is three years old.

If the antibody test is negative, it does not guarantee that he will never develop diabetes. Islet cell antibodies are present in 70% to 80% of children diagnosed with Type 1 diabetes. It is requested that children between the ages 3-10 be rescreened yearly and children between the ages of 10-20 be rescreened every two years.

There are two possibilities for a child’s high blood sugars.

One is transient hyperglycemia. This is a condition where high blood sugars occur in illness, stress or as a result of medications (such as prednisone). This condition can lead to diabetes in about 25% of the cases.

Uneven insulin production due to islet cell destruction, eventually leading to diabetes. In an islet cell antibody positive individual, beta cells are destroyed a few at a time. This can lead to low first phase insulin response in the presence of illness or an especially large influx of glucose (a large meal, for instance). It can take many years before the onset of diabetes.

To ease your mind, I would suggest glucose and ketone urine testing once a month and/or when the child is ill. This is less invasive and the urine strip can be pressed into the diaper if the child is still wearing them. If glucose or ketones are present, a blood glucose test can be done. Watch for symptoms of excessive thirst, excessive urination and/or weight loss and keep in touch with your pediatric endocrinologist.

HVS