December 8, 2004
Diagnosis and Symptoms, LADA and MODY
Question from Sedona, Arizona, USA:
This is a follow-up to my previous question.
My 10 year old daughter has undergone testing for diabetes over the past year and a half. Her GAD results were negative, as well as her tests for MODY3. She is a healthy weight of 100 pounds at 5 feet tall. She has never been overweight and is very active. She has not yet reached puberty. Her older sister has PCOS and type 2 diabetes. Her mother has PCOS and insulin resistance. Recently, she had a GTT. She ate a very high carbohydrate diet for four days prior to it. Her results are as follows:
Fasting 105 mg/dl [5.8 mmol/L]
30 minutes 139 mg/dl [7.7 mmol/L]
1 hour 159 mg/dl [8.8 mmol/L] 90 minutes 113 mg/dl [6.3 mmol/L]
2 hours 135 mg/dl [7.5 mmol/L]
Her insulin level peaked at 259.
The doctor who diagnosed her with insulin resistance due to the high insulin level, however, is baffled because her weight is fine. Due to her kidney disease, he is also testing her for MODY5. That has not been done yet.
Since she had such high blood glucose levels when she was ill and because her insulin is so high now, does this mean that she will develop type 2 diabetes? Does this indicate that she could also have PCOS and it has not yet surfaced because she has not yet reached puberty? Should I expect weight gain, as her sister had, when she hits puberty, due to insulin resistance? How could she have insulin resistance at such a healthy weight? Could this still be a MODY diabetes?
The endocrinologist’s suggestion was to keep her active and eating healthy and wait a couple of years to see how she develops. Is this reasonable? Should we continue monitoring her at home?
Answer:
This is far too complicated to answer without a more thorough exam and review face-to-face. In simple terms, what your endocrinologist has suggested seems quite reasonable. Close surveillance, particularly during periods of any illness, would also be reasonable. There is certainly insulin resistance, by definition, with such high insulin levels. The blood glucose levels themselves are in a gray borderline zone. They are not quite as normal as one would like, but not definably elevated under conditions of the tolerance testing. There are beginning to be some genetic tests available to help pinpoint different types of MODY and it may be reasonable to find out if these are being done, have been done or available where you are getting your care. One can be insulin resistant without being overweight and the insulin levels point to this likelihood in your daughter. Things can also change as the pubertal hormones increase. It is unlikely that the ureteral implantation surgery is related to this. It does sound like the endocrinologist is doing all the appropriate tests and keeping track of things that may change periodically.
SB
