January 16, 2004
Diagnosis and Symptoms
Question from Vancouver, Washington, USA:
Vancouver, Washington, USA My two year old was recently diagnosed with diabetes (12-23-2003). All antibody tests were negative. He had blood sugar readings up to the high 300s, lab confirmed. He was monitored for 6 weeks and levels were increasing. So the endocrinologist started Lantus 3.5 units with NovoLog as needed to treat additional highs.5 units for over 200, 1 unit for over 300. Within the last two days he seems to be entering a honeymoon as the blood sugars are stabilizing and insulin has had to be reduced.
They have stated they would like him and his one year old sister (who is now having high blood sugar) to go in for an oral glucose tolerance test and lab work. Although we know from monitoring his average blood glucose is about 180, his A1c test is reflecting 4.5 (an average of 80 or so). I am confused as to what is going on. Does he have diabetes?
They are doing lab tests to see if something in the blood is causing false low readings. Any ideas as to what specifically they may be looking for would be greatly appreciated.
Answer:
The A1c levels and blood glucose levels you describe are discordant. You should discuss this with your endocrinologist since having the actual values may help to explain this discrepancy. It is true that this could be a very fast honeymoon. Antibody negativity does not really help with very young children since they are often negative for reasons that are not well understood. And some antibody tests may change over time.
In any case, the blood glucose values are the best guide as to treatment and doses of insulin required. Having another child with similar abnormalities makes one think of variants of diabetes, not classical type 1 and this may be why they want more specialized testing to be done. Stay in close contact with your endocrinologist since it sounds like they are trying to sort all of this out.
SB
