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Question:

I have a nine year old son who was diagnosed with diabetes at age two, and we have two other sons. Our doctor asked if our three year old was checked, so we had a glycohemoglobin done. It was 4.8 which we understood as very good. One year later, our son does not exhibit signs of diabetes, except he on occasion wets the bed and is thirsty. We started checking blood sugars, and they were all over the place. On one day his sugars would be higher than normal -- anywhere from 150-247 mg/dl [8.3-13.7 mmol/L], although his fasting was only 60 mg/dl [3.3 mmol/L]. The doctor did another glyco and a C-peptide and an antibody test. The glycohemoglobin was 6.5%, and his C-peptide was 0.9, which I understood as low insulin production, though his glycohemoglobin is normal. They told me to check sugars for two weeks four times a day, and his fasting is perfect but somewhat low -- around 60 mg/dl [3.3 mmol/L]. Yesterday, we checked his sugars and it was 247 mg/dl {13.7 mmol/L] -- not fasting, but he had moderate ketones. The rest of the day, we continued to monitor, and his sugars were anywhere from 247 to 90 mg/dl [13.7 to 5 mmol/L], with negative ketones after the initial 247 mg/dl [13, 7 mmol/L] was down. Is this normal for this age and what should be done if anything? If there is something going on I would like to try anything to help his as we don't want any complications from this.

As it is, my nine year old son has microal buminuria -- high microalbumin and creatinine -- but plans on going on the pump shortly. His 24 hour microalbumin was 21 and his 24 hour creatinine clearance was 28 -- whatever that means. All we know is that it is slightly elevated, and it could possibly be the beginning of something with the kidneys.

Answer:

This is several questions.

An A1c of 6.5% is high in my lab, but may not be in your lab. A1c should not be used to diagnose diabetes. Likewise, home glucose meters should not be used to diagnose diabetes.

Still, it sounds like something is amiss. Have you asked your doctor about the DPT-1 There is lots here in CWD about it. You might want to consider it as a choice to learn about the three year old child's current state.

Now, the nine year old son with diabetes and the kidney questions. Testing for protein is a tricky business. Children frequently have more protein in the urine when they are upright than they do when sleeping. That's why it is important to know when the urine was collected.

It is hard to get 24 hour urines, so I use overnight urine samples. That does away with the question of postural proteinuria (protein from standing upright). I don't know how your son's urine was collected, etc. Also, if the creatinine clearance was done, it must be corrected for body size. It can get complicated. These are questions your diabetes team should be able to answer.

You are correct to want good information about kidney problems. Nine is pretty young to see changes, but it is good to look.

LD

DTQ-19990124102338
Original posting 31 Aug 2000
Posted to Diagnosis and Symptoms and Complications

  
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Last Updated: Tuesday April 06, 2010 15:09:14
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