My four-year-old son has had high blood sugar readings every now and then since he was two. He has always brought the level back down on his own and wakes up with a normal blood sugar. His A1c a year ago was normal and he tested negative for islet cell antibodies. Over the past couple of weeks, he has had a high blood sugar reading of up to 204 mg/dl [11.3 mmol/L], three to four hours after eating. He also woke up with a 138 mg/dl [7.7 mmol/L]. Do you think this is a sign of coming closer to an official diagnosis? His dad had type 1.

It is impossible to diagnose over the Internet. Were there other antibodies, such as IA2 and GAD65, checked besides islet cell antibodies? Some children, especially the youngest, may not have positive antibodies, so these tests are not 100% perfect for diagnosis. The correct diagnosis at the moment is pre-diabetes or intermittent glucose intolerance and, with a father with type 1 diabetes, it is likely that this will change. But, there is no really good way to know exactly when. Usually a growth spurt or a minor viral infection finally overwhelms the pancreas. So, be vigilant with change in thirst, urination, enuresis, unexplained weight loss and watch the blood sugars so that no DKA occurs if there is a major change.

SB