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July 15, 2007

Diagnosis and Symptoms, Other

Question from Atlanta, Georgia, USA:

My son was diagnosed with type 1 last August, just two weeks after his eighth birthday. I had access to a glucose monitor and knew that his blood sugar was high (498 mg/dl [27.5 mmol/L). I took him to the Children's Hospital Emergency Room (ER). They took many vials of blood for testing and admitted him. The next morning, the pediatric endocrinologist on call came by and informed us that our son had type 1. I asked what his laboratory values were and she said they were not all in yet, but that due to the symptoms and glucose levels, she knew that it was diabetes. I knew this too, but I was in denial and wanted proof. I had decided that maybe the islet cells had ducts and they were clogged up. In my eyes, I could not accept the diagnosis without laboratory tests to prove it. Every day of the hospitalization, I got the same answer: the test results were not in yet. We were discharged and had to follow up at the pediatric endocrinologist's office in one week. We saw a different doctor from the same group. He was gracious enough to look up the A1c and told me that it was 10.1 at admission and explained to me that this reading meant that the blood sugar average was 275 mg/dl [15.2 mmol/L] over the previous three months. On the next visit, I once again asked about the test results. This time, I was given a copy of them, but no explanation or reference values. I have been unable to find out much about the tests or what they indicate. I know it has been nearly a year and I have accepted the diagnosis, but I still need to know why the tests were run and what they mean. I feel as though I have bothered the staff at the endocrinologist's office to death and, frankly, I am beginning to wonder if they even know why the tests were run. Can you explain what they mean? I have read much about C-Peptide in previously asked questions, but I don't see where that was run on my son. I am listing the results and the values obtained: Endocrinology-B: Anti-GAD 0.7; Cortisol 6.6; A1c 10.1; Insulin 2; Insulin Autoantibodies 3.3; T3 uptake 31.28; T4 10.0; TSH 4.79. Serology/Immunology: Islet cell antibodies 1:8. Hematology: WBC 8.32; RBC 4.62; HGB 13.2; POC HGB CALC 12.2; HCT 36.9; POC HCT 36; MCV 79.9; MCH 28.6; MCHC 35.9; RDW 12.4; Platelet count 320; mean platelet volume 8.0; ANC 4.64; ABS Neitrophil 4.64; SEG 55.8; Lymph 35.9; Mono 3.5; Eosinophils 4.0; BASO 0.8; RBC morph normal. I realize that not all of the tests are going to be significant to diabetes diagnosis. I am really only interested in those that are significant to type 1 or those that are out of the normal range.

Answer:

It is hard to understand why your diabetes team could not explain these results since they are fairly standard. Without knowing the specific normal values, I would assume the following:

Normal thyroid function, although the TSH is a bit high. It would be helpful to recheck the T4 and TSH and also to run thyroid antibodies since Hashimoto’s thyroiditis is commonly associated with type 1 diabetes – about 20 to 40% of the time. It would also would be useful to check for celiac disease with an antibody test called transglutaminase antibody. Celiac disease is another autoimmune disorder associated with type 1 diabetes, positive in about 5 to 10% of cases and treated with a strict, gluten-free diet.

Type 1 diabetes antibody tests were positive so this confirms an autoimmune attack on the islets, consistent with diagnosis of type 1 diabetes mellitus. The general blood count was unremarkable. An A1c of 10% is very high and consistent with hyperglycemia for the past few weeks/months.

SB