August 22, 2005
Diagnosis and Symptoms, Insulin
Question from Plainview, New York, USA:
My 14 year old daughter, who is slightly heavy, was put on Glucophage, twice a day in October 2004 due to a high insulin level as a result of unrelated blood tests for growth at a pediatric endocrinologist. All her numbers were doing great. She had lost weight and was now average weight. On July 20, 2005, she was diagnosed with type 1 diabetes based upon four random blood sugar monitor readings over 200 mg/dl [11.1 mmol/L]. Specifically, she had one elevated reading per day on four consecutive days. Those readings were 357 mg/dl [19.8 mmol/L], 240 mg/dl [13.3 mmol/L], 228 mg/dl [12.7 mmol/L], and 204 mg/dl [11.3 mmol/L]. Her C-Peptide was.7 with no antibodies present. No GTT was done. She has been on one unit of Lantus and remained on Glucophage. Her blood sugars have remained very constant, generally 90 to 130 mg/dl [5.0 to 7.2 mmol/L] on this regimen. Are there any other types of diseases, other than diabetes, that could cause this high of a blood sugar reading? Do you feel this is a very early diagnosis of type 1? Do you agree with the use of insulin so early?
Answer:
Nobody could answer these questions without quite extensive consultations, review of blood glucose levels more than you provided, etc. However, all these blood sugar values are distinctly abnormal, so that the diagnosis of diabetes is correct. Antibody levels are only positive about 60 to 80 percent of the time at diagnosis so, if positive, then this confirms type 1a autoimmune diabetes mellitus; if negative, this is not so helpful for a diagnosis.
There is not much else that can cause such hyperglycemia. So, I would use insulin as you have described as well and aim for as close to normal blood glucose control without hypoglycemia as a treatment target. Avoiding obesity, daily exercise and frequent blood glucose monitoring are all keys to control. Stay in close touch with your diabetes team and, in fact, go back and ask them these same questions since they can give you the best answers for your child.
SB
