From Hawick, Minnesota, USA:
Six weeks ago, my adopted 14 year old daughter ( 5 feet 4 inches, 125 pounds) was found to have an elevated blood sugar during an examination for abdominal pain. Her lab results were:
TEST RESULT Fasting Blood Glucose 108-138 mg/dl [6-7.7 mmol/L] A1c 6.2% Insulin normal C-peptide low Antibody negative
She was recently evaluated by a pediatric endocrinologist, who has ordered more antibody testing, but who also said that my daughter has type 1 diabetes and offered insulin as an option for treatment now. Her blood sugars during the day are usually 104-140 mg/dl [5.8-7.8 mmol/L] about two hours after eating. Her birth mother had gestational diabetes, and she is tired a lot but has no other symptoms of diabetes. I have a few questions:
- Do you think my daughter has type 1 diabetes?
- Do you think that insulin injections at this stage could help prevent her from losing all her insulin production?
- Does introducing insulin at this time actually make her body quit making its own insulin?
It is often difficult to make a decision on starting insulin in a situation like this. At the present though the only evidence that you have in support of your daughter's diabetes is a series of fasting blood sugars that span the range between the upper normal level and the lower range of what would be considered diagnostic of diabetes. Technically, this represents impaired glucose tolerance, and, whilst this presages diabetes, it could also be stress in a 14 year old girl who has just been evaluated for abdominal pain. If no specific diagnosis was made, this has long been recognised as very often based on stress. The hemoglobin A1c was at the upper range of normal for most laboratories, but two hour postprandial blood sugars are normal, which is against a stress explanation of the fasting levels.
I think that your daughter probably has type 1A (autoimmune), but I would wait for the results of the ICA 512, GAD 65, and anti-insulin antibody tests before committing to a diabetes regimen. If two of these tests are positive, then it would be time to start insulin and learn the whole syllabus of good diabetes care. If only one test is positive, it might be reasonable to defer insulin until frank clinical diabetes is clear. A glucose tolerance test with insulin levels or an intravenous glucose tolerance test with two and six minute blood insulin levels could give a more precise estimate of how soon insulin would be needed. Giving insulin does not really affect the long term progress of autoimmune damage.
Your daughter is of average height and weight so that she is unlikely to have type 2 diabetes, but, especially if she is of Hispanic or African American descent, she might still have antibody negative type 1B (idiopathic) diabetes which usually requires insulin at least for the first few months.
Original posting 23 Dec 2002
Posted to Diagnosis and Symptoms
Last Updated: Tuesday April 06, 2010 15:09:40
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