April 7, 2007
Diagnosis and Symptoms
Question from South Dakota, USA:
Recently, my nine-year-old son has experienced frequent urination during school hours, which was addressed at school conferences. That next morning, I tested his blood sugars with his brother’s glucometer (his older brother has type 1 diabetes). For three mornings, his fasting blood sugars were 132 mg/dl [7.3 mmol/L], 143 mg/dl [7.9 mmol/L], and 128 mg/dl [7.1 mmol/L].
I took him to our family physician and they reported a laboratory glucose of 80 mg/dl [4.4 mmol/L] and a mid-range A1c. The meter was calibrated and was within 2 mg/dl [0.1 mmol/L]. The next night, he tested 155 mg/dl [8.6 mmol/L], approximately two hours after a meal.
Our endocrinologist considers him to be glucose intolerant at this point and recommends a wait and see approach. She did not recommend any screening for either type 1 or type 2 diabetes. We continue to test him three times a week with random blood sugars, a few even within normal range.
Is there a test recommended to determine if this is a very early stage of type 1 diabetes or type 2? He’s at the 100th percentile for his weight and height; he’s not obese. And, he’s very active. Next, if testing isn’t recommended, should we restrict carbohydrates significantly to take the pressure off the pancreas in hopes of slowing the progression of any type of diabetes?
Answer:
These are great questions, but there are no good answers available. There are antibody tests available (islet cell, GAD-65, insulin antibodies) that would indicate, if positive, that there was already inflammatory changes in the pancreas occurring. These really are research tests, however, since we do not have any safe treatment to postpone further beta cell demise. Restricting carbohydrates is reasonable, but there is also no scientific evidence to suggest that it works. Lastly, there are studies, such as the DPT-1, which are looking at first degree relatives under such circumstances. Your endocrinologists may already be part of the DPT-1 TrialNet or may be able to refer you to the nearest center if you have some interest since they could do such tests without any costs and also some other genetic research tests as well to assess risk.
SB
