December 17, 2007
Diagnosis and Symptoms, Insulin
Question from San Francisco, California, USA:
My 22-month-old son and almost five-year-old daughter have been diagnosed with pre-diabetes. They have done the antibodies test and both have come back negative (GAD-65 0.5 and A1c 6.2 and some other result I forget). My daughter’s MODY test came back inconclusive and we are waiting for my son’s results. My doctor is saying that we need to put them on a small dosage of insulin once a day. They are not sure what our daughter has; it may be a new mutation of MODY. They are waiting to compare with my wife’s MODY and son’s MODY results to see if they have the same string/mutation. Their results have been around 100 mg/dl [5.6 mmol/L] to 115 mg/dl [6.4 mmol/L] in the morning consistently, usually around 107 mg/dl [5.9 mmol/L] and around 120 mg/dl [6.7 mmol/L] to 160 mg/dl [8.9 mmol/L] two hours after meals. First we were told that nothing would be done if fasting/morning results were below 126 mg/dl [7.0 mmol/L] and over 200 mg/dl [11.1 mmol/L] two hours after meals. I realize their results are not normal but not in the diabetic range, however, due to their age, is it advisable to put them on insulin with results being only in the pre-diabetic range?
We will have a doctor’s visit in January and they will do another A1c test and discuss insulin options. Our office at Stanford (LCPH) has a rotation of doctors so it seems we get different answers. So, we just need another opinion. As you can imagine, our lives have been turned upside down. We are doing everything to keep them active and to eat healthy. We know a lot about diet/exercise as my wife has type 1 and is now on a pump; she became diabetic during pregnancy with our first child.
Answer:
Unfortunately, there is no answer to your dilemma since nobody really knows how to approach this problem. The blood sugar results you report are not normal, but not so high as to be dangerous. There are some research and clinical reports suggesting that a small dose of insulin in this very early pre-diabetic phase may help save the damaged pancreas from further destruction, or slow down the destruction and thus allow more insulin availability for a longer period of time. I would suggest that you stay in touch with one physician and identify that physician as your main resource. You can easily talk to the one that you like the best and request that this be a possibility. In fact, I might suggest that you talk to the most senior and experienced of your diabetologists since this is somewhat complicated. It is most important to keep close eye on the blood sugar levels since things may change and you would then know this instead of letting your child get ill, symptomatic, ketotic, etc.
SB
