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August 4, 2007

Diagnosis and Symptoms

Question from Knoxville, Tennessee, USA:

My 20-month-old son recently had a period of four days of vomiting. He was able to keep down fluids while taking Zofran. However, on the fourth day, he had what was diagnosed as a "hypoglycemic seizure" with blood sugars around 30 mg/dl [1.7 mmol/L]. He was hospitalized for three days and was seen by a pediatric endocrinologist. During the stay, he had some high blood sugars around 200 mg/dl [11.1 mmol/L] or so immediately after getting glucose, but they did come down to a normal range within about 24 hours. He also had elevated cortisol levels. They sent us home saying the low blood sugars were caused by the vomiting. However, when more laboratory work came back, we were told that he does have GAD antibodies. We are to take him to the endocrinologist every three months for testing from now on. So, I'm wondering what the chances are that he will actually end up with type 1 diabetes in the future. There is no family history of diabetes, but there is a family history of other autoimmune diseases (antiphospholipid syndrome and juvenile rheumatoid arthritis). Does having GAD antibodies automatically mean he will have diabetes? Any idea on the odds?


The antibody tests are not 100%, but the higher the titer and the more persistent, the higher the risks and odds that this will predict type 1 diabetes. This might explain the stress induced (i.e., viral) high sugars and even the low sugars if one assumes a “damaged” pancreas from autoimmune inflammatory changes; this is what the antibodies represent. The two other autoimmune family disorders indicate some nonspecific higher risk, but these are not the most commonly associated with type 1 diabetes development, just some susceptibility on a genetic basis. I would agree with close follow-up and especially checking blood sugars periodically, more with any kind of illness.