From Colorado Springs, Colorado, USA:
My 11 year old son lost 12 pounds over a 3 month period of time. His weight was within normal range before, and is slightly low now. He did not grow at all in height at all in almost a 12 month period, so we don't believe the weight loss was due to a growth spurt.
We are consulting with a pediatric endocrinologist now, and are waiting for the results of his antibody tests. Fasting glucose was 153 and two hour glucose was 176. The doctor feels that he may be in the early stages of diabetes, or perhaps even in the honeymoon stage. My question is, if my son does not have Type 1, how do you diagnose MODY syndrome, or what else can cause these elevated blood glucose levels? We are currently testing his blood 1-2 times per day and are finding his sugars to be going all over the chart, but are still staying below 200. My second question is, what does a 1 hour swing range of 70 points mean? He has had a before meal sugar of 90 and an after meal sugar of 170 -- and the meal is actually pretty "light".
I would normally need a lot more information before saying anything about the possibility of your son having diabetes, but I assume that you have already discussed this with your doctor. In the meantime the blood sugar data is certainly suspicious and the loss of weight and growth failure very characteristic. The antibody test will determine if he has autoimmune Type 1A Diabetes which will mean starting on insulin and going to school, so to speak, to learn all about keeping blood sugars normal.
There are now three recognised forms of MODY and MODY2 has many variants. Blood glucose control can be achieved in most instances without insulin though this is not always the case in MODY3. The diagnosis is usually made without confirmatory lab tests, which are not easy to get done, on the basis of insulin independence, a strong family history and a story often of being overweight.
There are other possibilities to consider if your son progresses to more overt clinical diabetes. The first is that in a small proportion of Caucasian children antibodies are not found and just exactly what the change causing the diabetes at a molecular level is not yet known. Over half the new onset cases in children and teenagers of Hispanic and African American descent are in this category however. There are also some very rare syndromes in which the diabetes is associated with findings like deafness. These usually show a line of inheritance along the maternal side and are called 'mitochondrial diabetes'.
The most likely possibility is that your son will turn out to have a typical antibody positive onset of Type 1 Diabetes albeit one that has been diagnosed very early. As you probably already know the autoimmune process has probably been active for several years. If this does turn out to be the case you might like to consider getting antibody tests done on any siblings. 1-800-425-8361 is the number to call to find out more about the national DPT-1 Trial which is exploring the possibility of using oral or small dose injected insulin to delay the onset of insulin dependance and you might, of course still be a candidate for this yourself.
Original posting 1 Apr 1998
Posted to Diagnosis and Symptoms
Last Updated: Tuesday April 06, 2010 15:08:58
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