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September 21, 2005

Diagnosis and Symptoms

Question from Evart, Michigan, USA:

My three year old son was diagnosed with type 1 two weeks ago with an A1c of 9.8 and ketones in his urine. An Anti-GAD test was done and came back zero. I was then told he does not have type 1 and could possibly have MODY. For some reason, I just don't believe he has MODY, although he will be having a test to confirm this. I have read that the antibodies disappear within weeks of onset. Not that I want it to be type 1 over MODY, but wouldn't it be quite possible that the antibodies would come up zero by now, not knowing when "onset" was? Also, if MODY is type 2 and non-ketotic is it still possible to have ketones in his urine?

Answer:

Antibodies are not helpful if they are negative since about 20 to 30% of kids have negative antibodies even at diagnosis. MODY would be a diagnosis to consider if there is a strong family history of type 2 diabetes in multiple generations. I would go back and discuss this in more detail with your diabetes team. The treatment will depend upon the actual blood glucose levels being achieved. There are some special genetic tests available commercially now in the U. S. for MODY genes and also studies from ISPAD (International Society for Pediatric and Adolescent Diabetes) via researchers in the Netherlands (that would not cost anything) that your diabetes team can use to help with the genetics evaluation of MODY or not. The ISPAD web site has links.

SB