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February 22, 2007

Diagnosis and Symptoms, LADA and MODY

Question from Central New Jersey, USA:

I have pre-diabetes, with a fasting blood sugars between 100 mg/dl [5.6 mmol/L] and 110 mg/dl [6.1 mmol/L] for the past three years. I am normal weight, 134 pounds at 5 feet, 6 inches, and I have never been overweight. I am 50 years old. My 18-year-old son has type 1 and my 86-year-old father, also thin his entire life, developed type 2 diabetes 34 years ago after being put on prednisone for ITP. But, his mother and many other relatives in his family also had adult-onset diabetes. Since being diagnosed with pre-diabetes, I have doubled up in the amount of time I spend exercising. I went from exercising two and a half hours per week to exercising five to six hours per week. I lost six pounds, going from 140 pounds to 134 pounds. Nothing is helping. My fasting sugars remain the same as before, and higher. In fact, I am even getting fasting sugars in the 113 mg/dl [6.3 mmol/L] to 118 mg/dl [6.1 mmol/L] range on my glucometer. My son's pediatric endocrinologist is telling me I should be tested for MODY. He said he finds it very hard to believe that I would develop type 2 diabetes due to my thin/normal weight. And, he said my family history makes him think I must have MODY (my father and his whole family had adult onset diabetes). My father has been on oral medications and never needed insulin. He also watches his carbohydrate intake and has always been well-controlled with fasting sugars in the 120s mg/dl [6.7 to 7.1 mmol/L]. He also has not experienced any complications of diabetes, even after 34 years with the disease. I realize the genetic tests for MODY are expensive and inconclusive many times. What should I do? Should I sit here and watch myself go from pre-diabetes to full blown diabetes? Exercise isn't working and my weight is normal. I plan to see my endocrinologist next week. I also have Graves' Disease, which is in remission after a two year stint with Tapazole.

Answer:

You are correct about the MODY question. You could spend a lot of money and not have a final answer about that. In the end, you would have to ask the question “what difference does it make?” There is evidence from previously published prevention trials that oral agents, such as metformin and the thiazolidinediones (Avandia and Actos), have been effective in preventing or delaying the onset of diabetes. You might want to talk with your endocrinologist about these agents. The other point to make is that you are not doing nothing. You have intensified your lifestyle in order to decrease your risk. The other side of the coin is that your sugars may have risen without your increased exercise and weight loss.

JTL