My 15-year-old son was diagnosed with type 1 two weeks ago. He was on insulin for only one week. He is totally off insulin and is doing fine with lower sugars. His A1c was 8.4% at the time of diagnosis, with no ketones. His antibodies, thyroid, and C-Peptide came back normal except GAD, which came positive (94). My son is non-obese with an athletic build. For the past six months, he has been doing intense bodybuilding exercises without supervision. The exercise included strenuous workouts after meals and before bedtime. He indulged in very high carbohydrate, protein and sugar intake which was four or five times more than his normal diet. After his diagnosis, he resumed a normal diet. Is his diagnosis right for type 1 or is he just having glutamine deficiency which athletes suffer and which could have toppled his glucose regulation cycle? We have no family history of diabetes. Overall, my son is healthy.

Overeating, by itself, does not cause hyperglycemia and high A1c levels. So, I would assume that this is a form of diabetes with some pancreas/insulin recovery. As he is not obese, it is not likely that he has type 2 diabetes, but there are other forms of diabetes that would show up in this manner and need to be checked out. C-peptide levels and antibody levels need to be checked sequentially at least a few more times to see if things are changing or normal. None of these tests are 100% sensitive and specific, however, so that his clinical course, what happens to blood sugar readings, whether or not fasting or postprandial values rise or not, all matter to interpret this. Most of us would not stop insulin, even if the doses were very small unless there was specific genetic mutation that said that we should use an alterative medication. (Some MODY types of diabetes, for instance.)

I would go back and work closely with your diabetes team to figure out a follow-up plan that keeps him healthy and safe. If you think that there may be some protein, amino acid, lipid or other very rare metabolic abnormalities, then appropriate special testing and consultation could also be obtained.

SB