Our six year old son has high blood fasting sugar levels regularly (120-130 mg/dl [6.7- 7.2 mmol/L]), but two hours after meals, he has normal levels (using a home meter). He tested negative for all antibodies (GAD, islet cell antibodies, anti insulin, etc.), and an oral glucose tolerance test showed good response. When he had a tonsillitis infection, his levels shot up but then went back to previous observations. Are there any indications of diabetes onset given these observations? What diet should he follow (zero sugar, carb counting, or normal)?

I always find difficult to address this sort of question where you are asked for a ‘second opinion’. However, given a very limited history at this point, I would not want to label your little son as having any kind of diabetes since the oral glucose tolerance test was apparently normal and so are the two-hour postprandial blood sugars. Therefore, I would first want to be sure that the monitor was calibrated correctly.

I would not put him on a diet at this stage. I am not convinced, without more details, that the tonsillitis story rules this out. Supposing however you get reliable fasting blood glucose levels in the diabetic range, then could he might have type 2 diabetes, Maturity Onset Diabetes of the Young (MODY), or one of the insulin resistance syndromes like Type A. I think then you might want to ask for a referral to pediatric endocrinologist for further help.

MS