November 16, 2000
Diagnosis and Symptoms
Question from Michigan, USA:
My son has had type�1 for nine years. We have many other types of autoimmune disorders in the family (vitiligo, rheumatoid arthritis, lupus). Recently, we checked my two year old son’s blood sugars and it was 300 mg/dl [16.7 mmol/L]. We then started checking several times a week — and about 30% of those sugars would be over 200 mg/dl [11.1 mmol/L], the rest being normal. We contacted our endocrinologist and she said that it sounds like we are in the beginning stages of diabetes with our next little guy. So, we had the DPT-1 screening done for him, and he came back antibody positive. So, now what is next? He is too young to enter the study — how long will it be before his progresses to becoming dependent on insulin? Given the fact that he has already had many high blood sugars and a positive antibody screening, is it possible that he may not advance at all to diabetes?
Answer:
I think you ought to ask your endocrinologist to get a hemoglobin A1c test done. Normally, this can be done in a few minutes in the office, and, if this is at or above the upper limit of normal, then I think that he should be started on insulin right away because it would indicate that average blood sugar had been above normal for some weeks. With a positive antibody test and these blood sugars, he must be on the brink of insulin dependence anyway, and the danger of waiting is that some intercurrent infection will precipitate ketoacidosis. In other words, I think that he already has diabetes, and the chances of it resolving at this stage and with your family history is essentially negative. You should also ask his endocrinologist about testing, as a precaution, for hypothyroidism and for celiac syndrome with an antitransglutaminase test.
DOB
