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Question:

From Kuwait:

We are from Pakistan and are residing in Kuwait. Our youngest daughter is seven and a half years old. Last year, in June, she was showing symptoms such as increased thirst, frequent urination, dry skin around the mouth and fingertips and she was very lethargic and inactive. So, we checked her blood sugar and it was as high as 21 mmol/L [378 mg/dl]. She had ketones and glucose in her urine. She was immediately admitted to the hospital was started with insulin treatment. She was given insulin three times a day before each meal.

We continued this treatment and then, when she went into frequent hypoglycemia, the dosage was gradually reduced and insulin treatment was stopped in September. We controlled her diet and monitored her blood sugar twice weekly in the morning (fasting) and it was within range (3.5 to 6.5 mmol/L) [63 to 117 mg/dl]. This continued until February 2005. Now, her morning readings are normal and within range. But, in the last four to five weeks, the result on the urine strips show high glucose level and her random blood sugar during the day is also high, 15 mmol/L [270 mg/dl]. So, the doctor's advice was to give her two to four units of fast acting insulin (Actrapid) before the evening meal. I'd like to know whether this is her honeymoon period and whether her honeymoon period is finishing now? What are the symptoms of the end of the honeymoon period?

I want a precise diagnosis as to which type of diabetes she has, type 1A or type 2B? Does she have MODY (because since her childhood she is on the obese side, her current weight is 31 kg (68 pounds) and when she was first diagnosed it was 36 kg (79 pounds). Her height is 128 cm. If it is MODY, then which type of MODY? What type of tests are needed to be done to confirm precisely what type of diabetes she has? Do I need to refer to an endocrinologist for further consultation because her recent C-peptide results were within range?

Answer:

I do think that, in light of what you write, your daughter quite probably has type 1A diabetes. For type 1B diabetes, you need the autoantibodies negativity. She's waning her honeymoon phase as her sugar levels are increasing and insulin is needed again. Her C-peptide levels must be checked trough a dynamic test like the glucagon test or IVGTT in order to assess the beta cell production and reserve. MODY in children (MODY2) is presenting much more subtly with no signs or symptoms of acute hyperglycemia nor ketones. Regarding a more precise diagnosis, I think a pediatric endocrinologist might be of some help.

MS

DTQ-20050402142448
Original posting 14 May 2005
Posted to Honeymoon and Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:10:02
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