July 16, 2005
Diagnosis and Symptoms
Question from Navarre, Florida, USA:
My six year old daughter has had type one diabetes since February 1, 2005. She had been sick for months and our family doctor could not figure out why she was staying so sick. All laboratory tests were normal, even her A1c. Her father and his brother both have type 1. Her fasting blood sugars were 160 to 200 mg/dl [8.9 to 11.1 mmol/L] at times. She would have the ketone breath, increased urination and abdominal pain. We finally took her to our endocrinologist and her fasting glucose was 187 mg/dl [10.4 mmol/L], A1c 6.1, and co2 level 18. All other tests, including C-peptide and insulin levels were normal.
Currently, she takes NovoLog 70/30, five units in the morning and five units in the evening. She was 42 pounds and now is 47 pounds and looks great. She eats very well. Her fasting blood sugars are 85 to 110 mg/dl [4.7 to 6.1 mmol/L] and she has an occasional 140 to 160 mg/dl [7.8 to 8.9 mmol/L] before lunch. I have stopped her insulin before due to occasional lows and her weight gain thinking we were wrong. But, within three days, she would be sick. Her fasting blood sugars would be 180 to 200 mg/dl [10.0 to 11.1 mmol/L] with abdominal pain. I would restart her insulin and she would be better. My husband is very brittle, with fasting blood sugars of 30 to 400 mg/dl [1.7 to 22.2 mmol/L] even with the pump on six different settings. He is 33 and has had type 1 32 years and has always been this way. In general, my daughter’s blood sugars are perfect. Ten units does not seem like a lot of insulin. Is she really a diabetic and we caught it early like our endocrine doctor says?
Answer:
Your daughter “really is” a diabetic. She may have entered the diabetes honeymoon, a time when her own pancreas is helping out some and producing some insulin. But, if you stop insulin and allow her pancreas to “do all the work,” the honeymoon will end and her glucose levels will be much more difficult to control. All diabetes honeymoons end. See previous previous questions on this web site for more information.
Yes, you probably caught this relatively early. But, it seems from what you wrote, that someone gave much more weight to the previously normal A1c value: the diagnosis of diabetes mellitus is NOT made based on an A1c; it is made with glucose readings and glucose readings previously in the 160 to 200 mg/dl [8.9 to 11.1 mmol/L] range should have alerted to other tests, I think. The A1c can relay how overall controlled the glucose value is over the preceding two to three months. However, if her averages were great two months ago but getting bad this month, the overall A1c may not reflect the current situation. Therefore, do NOT make a diagnosis of diabetes based on this. And, do not allow the A1c value to take the place of regular glucose checks at home.
As an aside, I do not really often abide by a diagnosis of “brittle” diabetes. More often, that really reflects someone who has not matched well insulin needs to meal planning and activity schedules. I hope your spouse is followed by an endocrinologist.
DS
