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Question:

From Knoxville, Tennessee, USA:

Our nine-year-old daughter has UCTD (undifferentiated connective tissue disorder) with symptoms of JRA (juvenile rheumatoid arthritis)/lupus/CREST (limited scleroderma). She also has mild asthma and mild hypercalcemia and hypercalciuria. She has routine laboratory work for monitoring by her rheumatologist. In the past, she has been on Tolectin, sulfasalazine, MTX, Enbrel, Plaquenil, Naprosyn and high dose aspirin therapy. Routine laboratory tests showed a random blood glucose of 158 mg/dl [8.8 mmol/L] and rheumatology sent us to her pediatrician. She was 119 mg/dl [16.6 mmol/L] approximately three hours after breakfast on the glucose monitor in the office. Her fasting laboratory work came back normal and her A1C was 5.6. Her pediatrician felt there was little to do besides watch and wait. Her next round of laboratory work showed a random glucose of 128 mg/dl [7.1 mmol/L], approximately four hours after lunch.

I know she isn't diagnosable at this point, but I was wondering if she should be followed by an endocrinologist. Our rheumatologist suggested a re-check in two months (for normal drug monitoring) unless she was symptomatic. All of this seems reasonable and our doctors have been wonderful with both our daughter and our entire family. Does this seem like she is moving toward diabetes? Are kids with autoimmune disease more likely to develop diabetes?

Answer:

The blood glucose values you report are definitely abnormal. The A1c only gives you average equivalent values and is not useful for a diagnosis. Exactly how often blood glucose levels and normal and normal would only be ascertained by a profile of blood glucose testing (we would usually recommend prior to each of the three meals plus one to two hours after all three for two or three days) to get a sense of how abnormal is pancreas function. It would also be helpful to have antibody testing (islet, GAD-65 and insulin antibody levels) to see if these are positive or negative. I would suggest a consultation with the local pediatric diabetes team since they would automatically know how to monitor and make treatment recommendations.

SB

DTQ-20070709192126
Original posting 23 Jul 2007
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:10:12
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