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Forum Name: Diabetes

Question: Diagnosing Type 1 Diabetes in Teen


 Aimee729 - Tue Apr 14, 2009 11:31 am

Our daughter was hospitalized for a kidney infection and was on IV and Rocephin ea. 12 hrs. for 3 days. While hospitalized, she began showing elevated random glucose levels- in the range of 127-194 mg/dL. Her glycohemoglobin was 6.2%. Fasting glucose 127 mg/dL with insulin 8.54 m/UL. All other bloodwork was within normal range. An endo was called in and he ran a Fructosamine (results 248 umol/L) and also a GAD-65 Ab (results 0.07 nmol/L- reference range <= 0.02).

This endo diagnosed her with Type 1 Diabetes.

Subsequent tests, for t-Transglutaminase IgA (results=1 U/mL, reference 0-3 negative).And a glucose tolerance test that we think was messed up by the lab, as we witnessed discussion by several technicians reading the lab manual on the correct way to do the test. Later we were told by the technician that the 4th and last (draw) was not necessary. Her blood was drawn only 4 times- yet there were 5 results for the test.

Glucose (fasting) 110, 203,338,106,370. (This last number is in question).
Insulin (fasting) 5.8, 13.7, 14.3, 5.7, 12.2. (Also questioning this number).

C-peptide= 1.6 ng/ml

This is an otherwise healthy, active (5'7", 136 lb.) teenager with no significant medical history and no family history of diabetes.

This doctor was not interested in repeating any of the tests. Our daughter is still monitoring her glucose levels which range fasting 110 to 150 2-hr. post meal. Obviously she has something going on and her body is not fully metabolizing glucose. We are under the care of a 2nd opinion endo- who just looked at the paperwork and agreed with the first doctor. Shouldn't we have 2 full independent sets of tests- especially since the first set were performed while she was in the hospital with over 104 fever and dehydrated from the kidney infection?
 Dr. N. Haider - Fri Apr 24, 2009 6:12 am

User avatar Hi Aimee729,
As you have mentioned, there is definitely something wrong with the glucose levels of your daughter. There are two values in the glucose tolerance test, 203 and 338, which are not ok.
Diabetologists all over the world follow the World Health Organization guidelines when diagnosing diabetes. Accordingly, a fasting glucose levels more than 126 mg/dl and a random blood glucose more than 200 mg/dl (or 2-hours after an oral glucose tolerance test) means the person is diabetic. Teenagers and children are growing, so doctors start them immediately on insulin as their health can be severely affected.
It is quite possible that your daughter got the kidney infection primarily because she had diabetes, as high glucose impairs body defenses and most bacteria love high glucose.
I hope that helped, and cleared some reservations you had.
Dr. N. Haider.
 Aimee729 - Fri Apr 24, 2009 9:02 am

What is your opinion about the C-peptide of 1.6 ng/mL (0.4-3.3 ref)?

Her endocrinologist thinks she is a very early diagnosis of Type 1 in the honeymoon stage. Would you concur?
 Dr. N. Haider - Wed May 13, 2009 9:57 am

User avatar Dear Aimee729,
It is not surprising that the c-peptide levels of a lot of people with diabetes may fall in the normal range, especially early in the disease.
For every unit of insulin produced in the body, a unit of c-peptide is also produced. Please note that currently c-peptide levels are used to assess body insulin production 'indirectly', and in the further division of diabetes into type I, type II or others. For diagnosis, glucose levels are used.
It'd be useful to follow your daughter's c-peptide levels, a rising level will show improvement in body's own insulin production. A fall in the levels will mean she'll need more insulin as medicine.
What you have shared with us so far, I agree with your endocrinologist. This honeymoon period can last from weeks to sometimes a couple of years. Please continue monitoring her glucose levels, as these numbers will start getting in higher range when that period is over.
I know this has not been easy for you and your daughter. But we should be glad that she will be getting better now. Best wishes for you.
Dr. N. Haider
 Aimee729 - Wed May 13, 2009 1:58 pm

Thank you for your reply. Our daughter is under the regular care of an endocrinologist. She checks her glucose on the average of 5 times a day, per her doctors orders. We also regularly see a nutritionist and a diabetes educator. Overall her health is good. If this is the honeymoon it is certainly easy. Her diet is close to what it normally was before, only slightly healthier. She is taking 2 units of Levemir at bedtime.

My concern is making a clear diagnosis and getting her the best treatment for her futrue health.

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