My two and a half-year-old son had an A1c of 5.8. His fasting blood sugars have been between 64 and 179 mg/dl [3.6 and 9.9 mmol/L]. Two hours after eating, they run from 94 to 215 mg/dl [5.2 to 11.9 mmol/L]. Today, he was 215 mg/dl [11.9 mmol/L], our first reading over 200 mg/dl [11.1 mmol/L]. We have been checking his blood for three weeks. He has no other constant on-going symptoms like thirst and hunger, just every now and then, but is much more cranky than usual and just doesn’t look healthy. Could this be the start of type 1? Does type 1 come on slowly sometimes or is it always a sudden onset? If not, do you have any clue what else it might be?

I am always a little bit concerned when I hear from families who are checking their childrens’ blood glucose levels for “no reason” but because they are concerned about diabetes mellitus.

You must be using a home glucometer. Whose is it? Is it calibrated and coded (if necessary)? Why was the HbA1c done? Who did it? Was it one of those home or mail away kits or was it done in the physician’s office?

In my experience, in the majority of cases, type 1 diabetes mellitus presents with symptoms for two to six weeks before the child is actually diagnosed. But, those symptoms, typically of increased urination and increased thirst (and sometimes weight loss or poor weight gain), certainly were there in retrospect, so if someone were looking for diabetes or had a high index of suspicion, then the diagnosis can be made much sooner.

Again, I presume that you are using a home glucometer of some sort. If so, some of the fasting levels that you report are also suspicious. If these are actually genuine serum glucose levels drawn from a vein and run in the laboratory, then confirmed fasting values over 125 mg/dl [7.0 mmol/L] are abnormal.

I’d advise that you take your child in for a complete check-up. Call to make an appointment but be sure you explain your concerns to the office staff/nurse/physician. I wouldn’t come in just as a “walk-in” because the physician’s office may not have the time reserved for such an important assessment. On the other hand, if your toddler begins to act more out of sorts, begins to vomit, then seek urgent care right away.

Perhaps there is more information that you didn’t share. For instance, if someone else in the family has type 1 diabetes (and you are using that glucometer on the child), then maybe you have urine ketone strips, too. If you do, check the child’s urine for ketones if the glucose is more than 240 mg/dl [13.3 mmol/L] and, if positive, call your pediatrician or a healthcare provider immediately.

DS