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January 11, 2010

Diagnosis and Symptoms

Question from Brazil:

Recently, the doctor performed several tests on my seven-year-old son. They found glucose in his blood. We are scheduled to meet with an endocrinologist in January. In the meantime, we are very concerned about our son and would like to know if his diabetes is possibly temporary. On December 12, our son had a 75 gram glucose tolerance test. At the first draw of blood, his insulin level was 8, blood sugar was 96 mg/dl [5.3 mmol/L]; after 30 minutes, his insulin level was 28, blood sugar 189 mg/dl [10.5 mmol/L]; after one hour, his insulin level was 23, blood sugar 240 mg/dl [13.3 mmol/L]; after 90 minutes, his insulin level was 39, blood sugar 251 mg/dl [13.9 mmol/L]; and, after two hours, his insulin level was 44, blood sugar 233 mg/dl [12.9 mmol/L]. Three days later, his plasma glucose was 78 mg/dl [4.3 mmol/L], HbA1c was 5.3, anti-GAD <1.0 U/ml; anti-insulin was <1.0 U/ml and anti-ICA512 was <1.0 U/ml. Daily home monitoring has found his fasting blood glucoses are between 73 and 119 mg/dl [4.1 and 6.6 mmol/L]. His postprandial readings have never been over 140 mg/dl [7.8 mmol/L]. He has not taken any insulin and he has no symptoms of diabetes.

Answer:

The fasting glucoses are normal. Other glucose levels are definitely abnormal so the technical diagnosis is glucose intolerance and this could develop into full-blown diabetes. He may also have a monogenic form of diabetes. You should consult with a pediatric diabetes specialist who can answer more specific questions, figure out a meal plan and monitoring and determine if special genetic testing or insulin treatment is needed.

SB