I am an RN who has had diabetes since age two (and presently on an insulin pump), and I have been testing my three year old son every other day for a month. Recently, he has had multiple high fasting blood sugars (150-200 mg/dl [8.3-11.1 mmol/L]) with negative urine glucose and ketones. I had him tested, his hemoglobin A1c was 5%, and his C-peptide was normal, but he had an islet cell antibody test result of 1.4 Should I be concerned about an ICA of 1.4? The pediatrician said to watch and wait. What is the likelihood of my son developing type 1 diabetes? It just doesn’t seem like anyone will give us a straight answer. If it’s is watch and wait — fine.Any information would be appreciated.

This is a positive islet cell antibody test, and the blood glucose readings you describe definitely are not normal, even though there are no sustained high sugars (thus no urine glucose) and no urine ketones. This could be the very early start of type 1 diabetes but more confirmatory tests would be needed to know this for sure. I would suggest you contact a pediatric diabetes specialist who works with your son’s pediatrician rather than waiting. Then the tests can be rechecked and a plan designed so that you should be able to avoid DKA [diabetic ketoacidosis], know when and how to start insulin, keep him out of the hospital, etc.

SB

[Editor’s comment: It’s not clear from your description if your son has had a battery of different antibody tests, or only one — if only one, a full battery would be appropriate.

WWQ]