From Weatherford, Texas, USA:
My granddaughter was ill and we thought she just had a virus. She had a temperature of about 103 degrees F one night, and 101 degrees F the next day. She complained of her tummy hurting and she had signs and symptoms of her typical allergies. He mom works for a pediatrician so she took her in to have her checked out that third day.
When her urine was tested, it showed she had dumped sugar and ketones. Her blood glucose with finger stick test was 250 mg/dl [13.9 mmol/L]. We were sent to Emergency Room for fluids and other tests. All tests were normal until today; the anti-GAD 65 showed 3.7. I can't find what the normal values should be. She had no islet antibodies. At the hospital, her first glucose test was 87 mg/dl [4.8 mmol/L], and then later, was 117 mg/dl [6.5 mmol/L], but the doctor thought all this was just a stress response to being ill.
The next day her glucose was in the 70s mg/dl [3.9 to 4.4 mmol/L], but the urine had some ketones. This week, we took her to the pediatrician again since she seemed to have a cold or sinus infection. She had lost five pounds, but her urine was without glucose or ketones. Now, with the GAD test, we are very concerned. We had already made an appointment with an endocrinologist, but that's not until November 3. There is no strong history of diabetes in the family, but my mother and I have hypothyroidism and my brother has psoriasis. The pediatrician says she may have autoimmune diabetes. Can you give us a rundown on exactly what autoimmune diabetes entails, the significance of the anti GAD test, and the probability that she is a diabetic?
You also can certainly search other Ask the Diabetes Team questions on this web site for related answers.
The presence of ketones simply means that the child had been breaking down fat for fuel in the hours before the urine test. We all have the capacity of breaking down fat and thus producing ketones. But. in the person with diabetes, especially type 1, the ability and need to break down ketones outpaces the ability to otherwise clear them out of the body. So, ketones can also reflect a degree of starvation. It was commonly said of diabetes, that one "starved in a sea of plenty." What that meant was that despite copious amounts of glucose, there was lack of utilization of that glucose because of lack of insulin. The body is "starving" for calories and this then forces the breakdown of fat for energy and the production of ketones.
So, high glucose (more than 125 mg/dL [7.0 mmol/L]) in the presence of ketones, and, especially in the presence of classic symptoms of elevated glucose (increased urination, increased thirst, etc.), sure makes a diagnosis of diabetes likely.
You've heard that "not all that glitters is gold"? Well, not all that is elevated blood glucose is diabetes. But it usually is. Or, at least reflects some degree of glucose intolerance.
As you have read and will continue to learn, if you read What is Type 1 Diabetes?, the usual cause of type 1 diabetes is an autoimmune process whereby the body's own immune system produces antibody proteins which "attack" the pancreas and interfere with insulin production. The common anti-pancreas antibodies attack specific proteins within the pancreas and/or the insulin producing cells of the pancreas, which are called the islet cells (pronounced "EYE-lett"). The common antibody proteins are
The antibody that is very commonly produced is the one against GAD 65.
- those against a protein called Glutamic Acid Decarboxylase (GAD) 65 [I forget where #65 comes from. Maybe it was the 65th sample that was analyzed....]
- ICA 512 (islet cell antibody # 512; this is also called IA2 and is also called tyrosine kinase)
- insulin itself.
You did not give the measured units of the "3.7" but I will presume that it was 3.7 Units/mL. Most people have ZERO measurable GAD 65. So, the normal range is essentially ZERO.
The significance is that the presence of this antibody increases the RISK of developing diabetes. Put it this way: smoking cigarettes is a risk for developing lung cancer. You know that; I know that; the government knows that; the tobacco industry knows that. But, you also know of people who have smoked all their lives who have not (yet) developed lung cancer. You also know of people who have never smoked but also developed lung cancer. But, all other things being equal, if you want to diminish your risk of lung cancer, then stop smoking.
Having any pancreatic antibody is a risk ratio. The "average" person or child has a low risk of developing type 1 diabetes. A first degree relative of a person who has type 1 diabetes has about a 5% chance of developing type 1 diabetes themselves. If that person also has pancreatic antibodies, their risk goes up to about 50% --a ten-fold increase! Would you go to Las Vegas knowing that you would win (or lose) ten times more often? It is a relative risk.
Autoimmune diseases run in families. Many cases of hypothyroidism and perhaps even psoriasis have an autoimmune basis.
So, I fear that your grandchild is at higher risk. She may have decreased insulin reserve capacity now. Please keep your appointment with the endocrinologist and I would suggest that you follow a diabetic meal plan and check glucose levels in the interval.
The pediatric endocrinologist may wish to repeat confirmatory or other complementary tests.
Original posting 15 Oct 2004
Posted to Diagnosis and Symptoms
Last Updated: Tuesday April 06, 2010 15:09:57
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