From Massachusetts, USA:
My 11-year-old daughter was in the Emergency Room two weeks ago with severe upper right quadrant pain. After chest x-rays, ultrasounds and a long wait, the only thing they discovered was her fasting glucose (after 13 hours and vomiting) was 118 mg/dl [6.6 mmol/L] and her liver enzymes were elevated. She followed up with her pediatrician the next morning and while her urine did not show any glucose or ketones, her A1c was 6.5. Over the weekend, she again vomited, and her morning levels were in the 120s and 130s mg/dl [6.7 to 7.7 mmol/L]. She was referred to Children's Hospital to see an endocrinologist some time next month, but they called back and said they wanted to see her the next day. We were told she was a diabetic and they suspect, based on her size, symptoms and family history (her father is MODY,and maternal grandfather type 1) that she is type 1. We are awaiting many blood tests including C-Peptide and insulin levels to help determine the best course to follow. The past two days, her levels appeared normal, 112 and 114 mg/dl [6.2 and 6.3 mmol/L] in the morning, and 121 and 129 mg/dl [6.7 and 7.2 mmol/L] two hours after dinner, so I was thinking (HOPING) she had been misdiagnosed. This morning, however, her fasting glucose was 173 mg/dl [9.6 mmol/L](was 118 mg/dl [6.6 mmol/L] before she went to bed). She had a big lunch today and, then, two hours later her glucose was 118 mg/dl [6.6 mmol/L] (perfect, right?). Is it possible that, at age 11, the numbers she is seeing are just due to hormonal fluctuations? Or, is it likely she is diabetic?
Your child could have MODY or this could be an early manifestation of type 1 diabetes. There are specific genetic tests available for MODY. Antibody testing (islet cell, IA2, GAD-65 and ZnT8) would be helpful, if positive, to confirm early type 1 autoimmunity. But sometimes antibody tests are not 100% foolproof as up to 20 to 40% could be negative. It is important to stay in close contact with your diabetes team and to monitor blood glucose levels as the ones you report are about 30 to 50% abnormal either pre-food or post-food. Should symptoms change, more urination, more thirst, unexplained weight loss, night time urination and/or enuresis, contact your diabetes consultants without any delay.
Original posting 10 Aug 2011
Posted to Diagnosis and Symptoms
Last Updated: Wednesday August 10, 2011 22:03:37
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