January 29, 2007
Diagnosis and Symptoms
Question from Colorado, USA:
Back in November 2006, I wrote to you concerning my five-year-old son who had an elevated blood sugar and large ketones. I have been monitoring him with a home meter since then. His fastings run from 100 mg/dl [5.6 mmol/L] to 128 mg/dl [7.1 mmol/L] with most being above 115 mg/dl [6.4 mmol/L]. His two hour post lunch readings range from 140 mg/dl [7.8 mmol/L] to 258 mg/dl [14.3 mmol/L]. I also take a nighttime reading, around five to seven hours after dinner, which ranges from 130 mg/dl [7.2 mmol/L] to 170 mg/dl [9.4 mmol/L].
I am very familiar with the diagnostic levels for diabetes using fasting, OGTT and random numbers with symptoms. So, I wanted to know what you think of these levels. I cannot find much information on levels of very early diabetes on the Internet. Do you think that this is likely the very early phase of diabetes? I also wanted to know at what point a doctor would treat blood sugar levels? Would a doctor wait until they are consistently over a certain blood sugar before starting treatment? Would that be over 200 mg/dl [11.1 mmol/L] postprandially? Over 150 mg/dl [8.3 mmol/L] fasting? I know what the diagnostic levels are, but I also understand there is a risk of treatment sensitivity.
Answer:
It seems that since those are mostly abnormal glucose values, this could be early diabetes or one of the variant forms of diabetes. There are new genetic tests available that may help sort this out, but you need to be in close contact with your diabetes team to help interpret these values. There are several philosophical approaches and no definitive scientific answers to your specific questions. Some of us would start insulin if restricting carbohydrates did not normalize these values and others would wait until there are more definitive symptoms with these hyperglycemic values. Periodic antibody tests would be helpful if the genetic studies do not provide answers that would suggest using a sulfonylurea for these rare types of diabetes. Family history would also be helpful to try to assess risks of type 1 versus other types of diabetes. Still, it is most important for testing to take place not only periodically but especially with any growth spurt, intercurrent illness or change in symptoms.
SB