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Question:

From Carlsbad, New Mexico, USA:

I am concerned that my 22-month-old son is developing type 1 diabetes. My husband's side of the family has a strong history of type 1. My husband has it, along with three of his siblings, two of his uncles, and one of his nephews. My son was not acting like himself recently, so, on a whim, I checked his blood sugar a few weeks ago. His fasting blood sugar was 125 mg/dl [7.0 mmol/L]. I checked it again later (after eating) and it was 282 mg/dl [15.7 mmol/L] and then, later, it was 257 mg/dl [14.3 mmol/L]. I took him to the pediatrician the next day and she did blood work and checked his urine. His fasting blood sugar was 92 mg/dl [5.1 mmol/L], his HbA1c was 5.0, and his urine was negative for ketones. She told me that his numbers from the day before were a fluke and that there was nothing to worry about. She will not refer us to an endocrinologist. I am concerned and feel like there is more going on. I have continued to check his blood sugar at home and he has had lots of normal readings, but also lots of out of range readings. He has had some 200s mg/dl [over 11.1 mmol/L] after meals, but it really just depends on the day. For example, yesterday his fasting blood sugar was 103 mg/dl [5.7 mmol/L], but three hours after dinner he was 164 mg/dl [9.1 mmol/L]. Can diabetes develop slowly? Could he have the beginning stages of type 1? I would really like him seen by an endocrinologist. Do you think his numbers warrant a trip to see one?

Answer:

I agree with you and your concerns and not with your pediatrician. It seems like this could be very early stages of type 1 diabetes where insulin deficiency is somewhat erratic and intermittent. Only about 3 to 6% of kids who have parents with type 1 diabetes mellitus have diabetes develop themselves and we believe that there is a high genetic component. So, please continue to check blood glucose levels and especially seek medical assistance if there is excessive urination, saturation of diapers, increased thirst or any unexplained weight loss - or any other unusual symptoms. Little babies, of course, do not let us know very many details except by our observation of their behaviors. I would agree that you should consult with a pediatric diabetologist who will probably check glucose and insulin levels simultaneously as well as islet cell antibodies. The antibody is often negative even with classical infant-onset type 1 diabetes; if negative, this won't help figure things out very much; if positive, it will confirm the ultimate diagnosis. Fasting blood glucose levels should be less than 100 mg/dl [5.6 mmol/L] in babies and less than 140 mg/dl [7.8 mmol/L] (really less than 126 mg/dl [7.0 mmol/L]) after eating so the intermittent values in the 200s mg/dl [over 11.1 mmol/L] are distinctly abnormal. Ongoing surveillance will be important to avoid DKA and hospitalization.

SB

DTQ-20110803151727
Original posting 23 Sep 2011
Posted to Diagnosis and Symptoms

  
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Last Updated: Friday September 23, 2011 10:33:54
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