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Question:

From Sedona, Arizona, USA:

During the summer of 2003, my then nine year old daughter was diagnosed with type 1 diabetes. She had a blood glucose level of 435 mg/dl [24.2 mmol/L]. At the time, my daughter was also ill with whooping cough and was on steroids for her breathing. Her high blood glucose levels continued only for a week, while she was on the steroid medicine. After this, she was basically normal, with an occasional high after a meal. Her doctor did a GAD test on her, which was normal. Her A1c was also normal as were her fasting blood sugar levels. From these tests, the doctors decided that she had intermittent hyperglycemia from the steroids and the illness and did not have type 1 diabetes. They decided that I should test her urine for glucose and ketones and test her blood glucose occasionally. Also, she has had several A1c tests since this time. Her A1cs have remained normal. Her fasting blood glucose has remained normal. Occasionally, her post-meal blood glucose is 150 to 180 mg/dl [8.3 to 10.0 mmol/L]. She is not on any medication, though we have her on a diet plan where she eats six small meals a day, balances carbohydrates and proteins and doesn't eat a lot of simple carbohydrates and sugar. She is also very active and into sports.

This is somewhat complicated with the fact that my daughter had a re-implantation surgery for her ureters when she was four years old, due to stage four renal reflux. She has not had any problems with her kidneys since, but the endocrinologist suggested that she could have MODY diabetes and it is under control with diet and exercise. She is asymptomatic for diabetes at this time. Her blood sugars are normal and her A1cs are normal. Her endocrinologist has recently done a test for her for MODY 3 and another GAD, the results of which we do not yet have.

My ex husband has hypoglycemia and insists that my daughter only has this and that she can go high after meals and then low, which would cause her A1c to be normal. The endocrinologist does not seem to know. He has not ordered at Glucose Tolerance Test (GTT). Should I ask him again to run a GTT if her other tests come back normal? Could she have hypoglycemia instead of diabetes? Could it be that she has nothing wrong and she just ran high due to the steroids and the whooping cough? Is it true that a girl may suddenly go into diabetes at puberty if her pancreas was stressed in the past? She will soon be 11 and is showing signs of puberty. She does not test very often any more and is having more occasions where she wants to eat sweets such as parties and events at school. I don't know whether she has to be careful or not or whether this is simply a non-issue now.

Answer:

It sounds like steroid-induced or stress-induced (from the infection itself) hyperglycemia that has not recurred. All such children and adults have some increased risk of developing diabetes later on and a type of MODY could also be possible. I would go back and discuss all this with the endocrinologist after the latest batch of tests results are available. Sometimes this could only be a form of hypoglycemia with some reactive hyperglycemia as a component, so your ex husband could also be correct. Some of this could merely be prelude to other forms of type 2 diabetes which would only then show up with excess weight later on. The longer the antibodies remain negative and the more the random blood glucose and urine glucose levels remain normal, as well as the less sensitive A1c levels, the less likely that there is any need to worry about recurrence. Eating in a sensible fashion, avoiding excess carbohydrates, especially simple carbohydrates, and maintaining optimum body weight for height are all reasonable and healthful ways to proceed as well.

SB

DTQ-20041027121843
Original posting 16 Nov 2004
Posted to LADA and MODY and Hypoglycemia

  
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Last Updated: Tuesday April 06, 2010 15:10:00
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