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March 19, 2013

Diagnosis and Symptoms

Question from Vermont, USA:

When she is sick, my 13-year-old has symptoms of diabetes including high blood sugars in the 150 to 250 mg/dl [8.3 to 13.9 mmol/L] range and an elevated HbA1c. The doctor sent us for tests. My daughter she was positive for two out of three antibodies, GAD-65 and mIAA. She still hasn't needed insulin but we watch what she eats and test her when ever she is sick. She also has a complete IGA deficiency which, according to her immunologist, indicated that she is likely to have some type of autoimmune disease. I was diagnosed with type 1 diabetes at 14 years of age and I had a similar experience except I was never tested for the antibodies. I want to keep ahead of this and not let her be as sick as I was, with a blood sugar of 998 mg/dl [55.4 mmol/L] at diagnosis. Do you think there's cause for concern with her? There is type 1 diabetes on my husband's side of the family, too.

Answer:

Antibody positivity is not a guarantee that your daughter will get diabetes, but with your family history and your own type 1 diabetes, risks are fairly high. However, no one can tell when this will happen exactly. Cutting back on simple sugars seems reasonable and may help preserve some insulin production from this autoimmune attack. In some studies, eliminating gluten also seems to be helpful although this is a difficult task to carry out. The key is to remain aware of these risks and with increased urination, increased thirst or unexplained weight loss, checking blood glucose levels will let you all identify high sugars before she gets very ill – and then start insulin. I would follow antibody levels once or twice a year to see if they are rising and also follow periodic home blood glucose profiles as well as A1c to see if those give you some clue that things are deteriorating before she gets symptomatic. You should stay in touch with a local pediatric diabetologist who can help you track these things sequentially. There also are some research studies that may be of interest. Your diabetes team can provide you specific contact information as well.

SB