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July 20, 2008

Diagnosis and Symptoms, LADA and MODY

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Question from Suwanee, Georgia, USA:

My 11-year-old son was recently diagnosed with diabetes. His only symptom was fatigue so I took him to the doctor. His fasting results on different days were 131 mg/dl [7.3 mmol/L], 104 mg/dl [5.8 mmol/L], and 121 mg/dl [6.7 mmol/L]. His A1c was 6.6 and his glucose tolerance test results were 219 mg/dl [12.2 mmol/L] after 1 hour and 245 mg/dl [13.6 mmol/L] after the second hour. So, we were sent to the hospital. The three mornings in the hospital his fasting readings were 104 mg/dl [5.8 mmol/L], 116 mg/dl [6.4 mmol/L], and 125 mg/dl [6.9 mmol/L]. Since we have been home, his fasting readings have been 119 mg/dl [6.6 mmol/L], 104 mg/dl [5.8 mmol/L], and 108 mg/dl [6.0 mmol/L]. Two hours after meals, his levels have been 121 mg/dl [6.7 mmol/L], 126 mg/dl [7.0 mmol/L], 159 mg/dl 8.8 mmol/L], 155 mg/dl [8.6 mmol/L], 179 mg/dl [9.9 mmol/L] and 128 mg/dl [7.1 mmol/L]. He is not on any insulin.

The doctors at the hospital said he is presenting like he could possibly have MODY. My grandfather had type 2 in his 50s and was very thin. His mother also had type 2. On my husband’s side, his grandfather was thin and his mother heavy; both had type 2 and my husband’s sugar runs high as an adult. My husband need to lose about 30 pounds. We have no type 1 in the family.

So, does this sound like the honeymoon period? We are waiting on antibody test results. If there are antibodies, then is this definitely type 1? If there are no antibodies, do you think genetic testing is a good idea to determine MODY or, in your opinion, is there another path we should take to find out what is going on? The doctor at the hospital said he doesn’t think there will be any antibodies, but he also said he could be wrong. Do you have any other ideas of what could be going on with my son? He doesn’t have glucose in his urine and is symptom free. He is not thirsty or running to the restroom. He is not too hungry and is still very active playing with is friends.

Answer:

From: DTeam Staff

It could be early type 1 diabetes presentation in which case antibodies may be positive (but they can be negative in about 20 to 40% of still autoimmune type 1 diabetes). It could be a type 2 presentation as well since this is present in your family. Many would aggressively treat him to try to normalize blood glucose levels even if this requires insulin and hope that this either saves his pancreatic function for a longer period of time or prevents long term hyperglycemia related complications. It does not make much sense from my perspective to treat him like your husband and just keep fingers crossed that high sugars do not do long term damage since this is contrary to all diabetes research. It is puzzling why your husband is not being treated if he is overweight and has persistent hyperglycemia so equally puzzling why your child would not be treated.

SB