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October 7, 2005

Diagnosis and Symptoms, LADA and MODY

Question from London, England:

My six year old daughter was diagnosed with pediatric diabetes three weeks ago after testing for a urinary tract infection. She weighs 22.3 kg (49 pounds). Her random blood glucose level was 6.6 mmol/L [119 mg/dl] and she had no ketonuria. Her A1c was 6.75. A subsequent glucose tolerance test indicated a blood glucose of 6.8 mmol/L [122 mg/dl], 11.8 mmol/L [212 mg/dl], 17 mmol/L [306 mg/dl], 18.7 mmol/L [337 mg/dl] and 20.2 mmol/L [364 mg/dl] and insulin levels of 4.4, 9.2, 0.7, 7.5, 7.6. Her islet cell antibodies test was negative. Her insulin antibodies level was 5.4 mg/l (0-5) and her GAD was 7.6 u/ml (0-1). We are testing her blood sugar three times per day and it ranges from 5.6 to 17 mmol/L [101 to 306 mg/dl] depending upon what she has eaten. She has no urine ketones and is completely asymptomatic.

She is on quite a restricted diet. We just received the GAD test result and I don’t know how to interpret it. Prior to receiving it, the doctors thought there was a potential of a MODY diagnosis. My daughter is not yet being treated with insulin as the doctor believes that since she is managing her blood sugar levels, she might go hypoglycemic with the addition of insulin. I know that in the U.S., treatment with insulin is much more aggressive as there is the notion that it “saves” the insulin production that is present (as opposed to being a crutch). So, given the GAD results, do you think that there is any hope of MODY? Would you recommend insulin treatment as soon as possible? Are you aware of any studies, anywhere in the world, to prolong her insulin production? she was diagnosed three weeks ago and is six years old and weighs 22.3 kgs.


From: DTeam Staff

These are all excellent questions, which I would encourage you to ask your diabetes team since they know your child best. The blood glucose levels you describe are distinctly abnormal so that most pediatric endocrinologists around the world would treat such a child with insulin. At this point, a small dose of insulin may suffice, but all should be based on attempts to normalize the blood glucose levels while avoiding/minimizing hypoglycemia. With the new basal insulins, such as Lantus, once or twice a day plus prandial analogs such as Humalog or NovoLog, this should be feasible. The data about saving pancreatic function is not very strong scientifically, so, it is difficult to know how to answer such questions. Also, it is likely that this is just a slower onset or earlier detection of autoimmune diabetes rather than MODY with positive antibodies.