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February 23, 2005

Diagnosis and Symptoms, Honeymoon

Question from Piscataway, New Jersey, USA:

During a routine examination on December 24, 2004, the pediatrician found sugar in my four year old son�s urine and sent us to emergency room. In the hospital, he was admitted with a blood sugar of 325 mg/dl [18.1 mmol/L] and diagnosed with type 1 diabetes. After nine hours of fasting, his blood sugar was 115 mg/dl [6.4 mmol/L]. No OGTT has been performed. Two months after his diagnosis, he is on a half of unit of NPH in the morning, a half of unit of NovoLog at breakfast and dinner and one unit of Lantus at night. His blood sugars are generally very good. For several days, he had many of his fasting numbers below 100 mg/dl [5.6 mmol/L]. He tested negative for all antibodies tests (ICA, IAA, GAD). Could it be that my son is still honeymooning or could it be one type of MODY or type 1B? We are Caucasian, therefore, we do not have the profile for either MODY or Type 1B. If so, are there additional tests to be done? I understand he presented the clinical symptoms of diabetes, but all the other tests came back negative. How is that possible?

Answer:

It’s hard to call a blood sugar of 325 mg/dl [18.1 mmol/L] not diabetes. It is likely it was early and you are seeing a nice honeymoon. I would recommend you test his blood sugars one and two hours eating, especially with some significant carbohydrates/simple sugars. If they aren’t normal, that should satisfy you that he has diabetes.

LD