August 4, 2003
Diagnosis and Symptoms
Question from :
From Nova Scotia, Canada
Since my husband has type 1 diabetes when my two year old daughter was showing signs of increased thirst, I asked him my husband to check her sugar levels. He let her eat approximately 90 grams of carbohydrate, checked her an hour and 15 minutes later, the reading was 13.3 mmol/L [239 mg/dl]. Then he washed her hands, checked again on another machine, and got a reading of 12.6 mmol/L [227 mg/dl]. An hour later, her level was back to 6.8 mmol/L [122 mg/dl].
We took her to an endocrinologist who said she is likely developing type 1, and since that time (three weeks ago) we have been monitoring her levels, but she has never had another high reading even when she has eaten a very large amount of carbohydrate. I wonder if her thirst was just the hot weather and if her hands were clean enough at the time she was checked. She did not appear ill at the time and a urine sample at the hospital which was fine.
Assuming the readings were accurate, are there any other explanations? Can people just have a unexplained reaction like this, or is it a clear sign of the onset of diabetes? Is the islet cell antibody test a good choice for us? Do you think my daughter will probably develop diabetes? How soon?
Answer:
You describe quite a common scenario, and it’s never an easy situation. Of course, it is possible that your daughter will develop type 1 diabetes because her risk is higher that average, but it is still only about 6%. Nonetheless, she obviously doesn’t have it at the moment.
In the UK, we do not believe in antibody testing except in clinical trials because absence doesn’t necessarily mean no risk, and presence does not mean certainty. However, in circumstances like your daughter’s, I would sometimes be persuaded to add antibody testing (islet cell antibodies and anti-GAD) in order to be in a better position. Doing a formal glucose tolerance test on a child of two is difficult but not impossible. The other test that could (and probably should) be done is a hemoglobin A1c test to assess whether her average glucose is raised. Then it’s down to careful observation and waiting — and I know that this is not what you want to hear.
KJR
