Question from Bay Springs, Mississippi, USA:

In December 2008, my eight-year-old daughter started complaining of headaches and blurred vision after meals. My father-in-law, who is diabetic, randomly checked her blood sugar a couple of times and got results ranging from 180 mg/dl to 200 mg/dl [10.0 to 11.1 mmol/L]. Since I am a registered nurse, I decided to buy my own glucose meter to investigate this. I continued to get high results including 130 mg/dl [7.2 mmol/L] fasting and up to 300 mg/dl [16.7 mmol/L] after meals. I quickly got her in to see our family physician who referred us to a pediatric endocrinologist. Her first laboratory tests were as follows: fasting glucose – 90 mg/dl [5.0 mmol/L]; glucose tolerance: one hour – 223 mg/dl [12.4 mmol/L], two hours – 198 mg/dl [11.0 mmol/L]; insulin 6.8u U/ml, Hemoglobin A1c 6.4%, GAD 0.23 nmol/L, Insulin ab-Human <3%, Islet Cell Autoantibody <1:2, Islet Cell IgG Autoantibody 5. Her BMP (basic metabolic panel) was all WNL (within normal limits). My daughter is 91 pounds, 55 inches tall and not yet been through puberty. The endocrinologist suspected MODY. Neither my husband nor I have diabetes but my husbands' parents both have type 2. They did the genetic testing for MODY and it came back inconclusive due to laboratory error. The endocrinologist diagnosed her with diabetes, type "unknown." He did state that her autoantibodies were "borderline" positive. Now, her diabetes is getting worse. Her fasting levels are mostly normal but when she eats anything, her levels shoot up to 300 mg/dl [16.7 mmol/L]. We have been mostly controlling her diabetes with diet and NovoLog pen sliding scale: 200 mg/dl to 300 mg/dl [11.1 to 16.7 mmol/L] - one unit, >300 mg/dl [16.7 mmol/L] – two units. In the last few weeks, the insulin is not bringing levels down to target levels and, if it does, it takes three or four hours, leaving her with a 300 mg/dl [16.7 mmol/L] blood sugar for three or four hours. I have scheduled an appointment with the endocrinologist. With the GAD and Islet Cell IgG “borderline” high, does this sound more like type 1 caught in an early stage and not MODY? Do the autoantibodies need to be rechecked? How high can the blood sugar be without returning to normal to be considered an emergency?