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Diabetes 1.5?


Jean in Newcastle
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Dh and his mom and two sisters are all diabetic.  They do not have type 1 diabetes.  They do not have type 2 diabetes.  Theirs is genetic but their doctors have not done any special testing to see what form of a  number of diabetes 1.5 types they have.  Now dd12, who is a very thin and fit runner, is having crazy sugars.  She's also having migraines and having everything go black in front of her eyes and dizziness.  My mommy gut says that it is all related but the pediatrician doesn't think so (though he isn't listening to me on the whole bloodsugar thing because he says her numbers aren't "technically" diabetes).  Instead, he's focused more on neurological issues and the fact that she has a rare benign in her eye (that we've known about for a couple of years).  This part is covered - we have a million (ok, slight exaggeration) appts. already set up to check out the neurological/ tumor possible connection.  

 

So. . . my question for the Hive.  Any experience with any of the non standard diabetes?  Treatments?  What do you do for meals for a child who does not have a weight problem but can't handle many carbs?  (Plus she is allergic to nightshades - tomatoes, all peppers both spicy and not, and eggplant).  Anything I should know about the subject in general?  

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I'm not sure I understand. A person can be thin and have type 2 diabetes. If it isn't type 1, then it is type 2, and yes there is an obvious genetic component. (My dad was a thin type 2 diabetic. All my siblings and I have some degree of insulin resistance, though measuring that is controversial. I have PCOS. eta, my siblings and I are all thin. Two of them recently stopped eating gluten and say they feel much better - I am not sure whether a reduction in carbs alone helped or whether it was the elimination of gluten specifically. Both are still able to eat it on random occasion. One of them was taking metformin and I thinkmhe might have stopped.)

 

For a child, moderating carbs would be an enormous challenge. I would aim to balance all carb meals/snacks with protein and fat, in terms of timing. I would replace amounts of energy from some carbs with energy from fat, to the extent possible and without going all the way down to ketosis (so I would have a minimum of 150 g carb per day; not sure how much the max should be). Just thnking out loud...

 

I agree with trying a ped endocrinologist even though I am not sure what they would say. It sounds like there is some sort of dysfunction no matter what it is called.

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How much fat is in her diet? I would be tempted to try smoothies with coconut milk, almond butter, etc. and coconut oil where it can be put in food. If she can have dairy, then butter, cream, cheese. And the fattiest cuts of meat like chuck roast, chicken thighs, more fat in hamburger. And most of all, if you think you need another medical opinion, get it. GL

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I would take her to a pediatric endocrinologist. While I think an A1C is a good idea, I think a glucose challenge would have more useful knowledge. I have really good A1Cs these days, but if I have a lot of carbs I sure do have a blood sugar spike. It would show how her body handles the sugars. My gestational diabetes endo told me to have all my kids do a glucose challenge when they were teens (bc of my GD and the family history).

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Jean, maybe try a google search of Paleo** lunch box ideas. So many ideas for a wide range of palates, but low-carb, appealing to kids kind of foods. It can be a jumping-off point to figuring out a few meal combinations for her to try.

 

Low-carb doesn't only have to be for weight loss issues. It can be healthy for average, healthy weight people as well. I've actually even read (only anecdotal) stories of underweight people using low carb/paleo** to gain weight. So it seems this style of eating can possibly be considered to be more of a weight stabilizer, either way.

 

I have no advice on the doctor stuff.

 

:grouphug: I hope you get it figured out soon.

 

**I'm not trying to push only Paleo, but that is the low-carb way of eating that I am most familiar with, and where the bulk of my personal research has been (Primal actually).

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Ped. refused to run an A1C.  I can go around him directly to a pediatric endocrinologist and probably will.  I'm figuring out some ideas for food that she likes.  She's going to have to stretch a bit, which is not a bad thing.  

 

Wow. Why in the world would he refuse that? It's not exactly a big deal.

 

The local hospitals/clinics around here have a once-a-week program where you can just walk in and request common bloodwork at low cost (A1c is $15), no doctor's order needed. Maybe you have something similar locally? A1C is one of the available tests. I've also seen home A1c monitors available at the pharmacy. 

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You are incorrect. Look up MODY Diabetes aka diabetes 1.5.

That's very interesting - I never heard of that before! (It sounds a lot like my family; my dad's dad was also diabetic). What is especially interesting is that there might be more options besides the usual treatment recommendations.

 

However, if a person hasn't had a genetic test, how can one be sure they have this? Is that your complaint about your dh's family, that they haven't been checked for the gene?

 

I would contact the people at the U of C website to find out about getting your dd tested for the gene, who to see, pros and cons, and cost. I am tempted to get myself tested too.

http://monogenicdiabetes.uchicago.edu/who-should-be-tested/testing-for-neonatal-diabetes-and-mody/

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Dh's family has not been tested that I know of.  But dh's endocrinologist did say that dh had it so I'm not sure if dh himself was tested or not.  I do know that dh's family has a tendency to pancreatitis and problems of that nature.  We certainly were not given much information on it.  We've done more research on our own on diabetes in general than anything we've learned in a diabetes education session made available by the endocrinologist.  

 

I really really was surprised that the ped. refused the test but he did test her for other things with a blood test so that may include at least a non-fasting glucose reading (though I'm not sure how much help that would be).  I absolutely know that her bloodsugars are going up to 160 two hours post-prandial if she has something like a roll.  That's not the ped's magic number but it is not normal.  This ped. is usually really really good.  The Dr. was having a very bad day healthwise himself  (I thought he was going to throw up during the exam, he was having such a bad allergy attack) and I think it threw him off.  Plus, it is hard to sort out all of dd's symptoms esp. in light of her tumor which no one really knows much about.  But having said that, I will pursue more if I feel like dd needs it.  (First we need to get some other tests already ordered out of the way so that we have more data going into this.)

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Jean, there are A1c at-home test kits available. Bayer has one that gives results after 5 minutes ( I think) for $40 for 2 tests. Reli-on has a mail-in one for $15.

 

I know some parents have seen their children have slow onsets for Type 1, even though that is not the norm. The old school approach is to wait until bg is >200 or so before prescribing insulin. Some more progressive endos will start very low doses of Lantus, even when post-prandial bg's aren't high enough for Humalog/Novalog. The thought is that by reducing the load on the pancreas, endogenous production of insulin can be prolonged.

 

In any case, at her age, I would definitely be considering Type 1 before thinking 1.5. Horses and zebras and all that.

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Jean, there are A1c at-home test kits available. Bayer has one that gives results after 5 minutes ( I think) for $40 for 2 tests. Reli-on has a mail-in one for $15.

 

I know some parents have seen their children have slow onsets for Type 1, even though that is not the norm. The old school approach is to wait until bg is >200 or so before prescribing insulin. Some more progressive endos will start very low doses of Lantus, even when post-prandial bg's aren't high enough for Humalog/Novalog. The thought is that by reducing the load on the pancreas, endogenous production of insulin can be prolonged.

 

In any case, at her age, I would definitely be considering Type 1 before thinking 1.5. Horses and zebras and all that.

Well, see this was my thinking when I asked for the A1C because I thought that if he could see that her sugars really aren't good and that this isn't a fluke, that he would help to keep her pancreas from totally tanking.  He brushed me off when I said that.  

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I have family with type 1, 1.5, and 2.... My understanding is that they don't consider it LADA until 25-30. Those with 1.5 in my family have been in their 40s and with type 1 siblings and/or parents. You could always have antibodies tests run, but I would guess type 1 is more likely.

 

My endo recommends trying South Beach first and watching how you react to complex carbs and fruits if blood sugars aren't super crazy.

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Well, see this was my thinking when I asked for the A1C because I thought that if he could see that her sugars really aren't good and that this isn't a fluke, that he would help to keep her pancreas from totally tanking. He brushed me off when I said that.

From what I have read, that is probably the typical reaction, even from most? ped endos. It would take a fairly unusual endo to proactively treat.

 

Testing for GAD and the other antibodies associated with Type 1 is something else that might be pursued at some point. That would probably be a hard sell too!

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I would nail down specifics of exactly what would concern my doc, and hold his feet to the fire over it. I would consider pitching a fit along the lines of "just how sick does my kids have to be to worry you." Sorry, but I am so sick of doctors and their numbers. Hey, doc--look at the patient in front of you or send me to someone who will. All kinds of people are miserable with subclinical trouble that they'd like to have stay subclinical or resolve. A doctor should be happy to have such a patient. (My DH works in the medical field, so I hear more than my fair share of crappy stories.) 

 

Anecdotally, I have a friend with wonky but not diagnosable blood sugar issues, headaches, etc. She has a pituitary tumor that affects her vision. She has PCOS, and everything that she has clusters around that. Whether the tumor came first and caused PCOS, who knows. She has had trouble since menarche. I tend to think it's going to be one ball of wax, but will a doc say so?

 

Would it help to load up on good fats, stay away from grains, and use fruit to up her carbs when she's going to run? If she's got much of a metabolism, it could be tricky to control these sugars, I would think.

 

Hugs.

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Well, see this was my thinking when I asked for the A1C because I thought that if he could see that her sugars really aren't good and that this isn't a fluke, that he would help to keep her pancreas from totally tanking.  He brushed me off when I said that.  

 

Have you charted her sugars on paper and then taken the results to him rather than giving him specific instances of how high they will go?

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I'm in the process of doing this.  This has all hit suddenly - actually a week ago yesterday.  She had complained some in the past of having her vision go dark when standing up but I figured it was the normal low blood pressure thing that you can get when you've been sitting for a long time.  Then a week ago, she had it happen while she was up and about and hadn't been sitting.  She said everything went dark, her legs got all wobbly and then she went into a migraine.  I should have tested her sugar then but had her eat and drink thinking she could be hypoglycemic and/or dehydrated and being focused on making her feel better, didn't think to test first.  She went to bed with an analgesic (which usually cures her migraines by morning) and she woke up still with a headache.  I took her bloodsugar then and her fasting sugar was 109.  Not a huge number but still not a normal fasting   So we tested all day and her numbers were off all day - again, not huge 200 plus numbers but in the 140 - 160 range after meals.  That's when I made the doctor's apointment for her.  But her file has a big red flag because of her tumor.  So all attention went to that as a possible cause of the symptoms and very little attention went to the bloodsugar readings because they weren't "bad enough".  So I've been busy making all the appointments to check her out neurologically etc. and been working on trying to monitor her sugars plus figure out meals so that we can see how she does with low carb.  Good thing we haven't started school yet!  

Have you charted her sugars on paper and then taken the results to him rather than giving him specific instances of how high they will go?

 

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That's nuts; it's a simple blood test.  Maybe look for a new doctor who will listen to you and not balk at a cheap and easy blood test?  What was his/her reasoning on this, especially with your family history?

 

Hope you get some answers soon; that's some scary stuff.

 

Regarding the blackout stuff:  When I was a teen, I would black out from low BP without explanation or cause (like, I would be sitting and in the process of standing up).  It did just go away on its own, in my very early 20s.  I still don't know what caused it, or why it went away.  But it happened irregularly, and the episodes were fairly wide apart in time.

Ped. refused to run an A1C.  I can go around him directly to a pediatric endocrinologist and probably will.  I'm figuring out some ideas for food that she likes.  She's going to have to stretch a bit, which is not a bad thing.  

 

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That's nuts; it's a simple blood test.  Maybe look for a new doctor who will listen to you and not balk at a cheap and easy blood test?  What was his/her reasoning on this, especially with your family history?

Reasoning was that it wasn't high enough numbers?  I'm not sure.  It's complicated by all of her symptoms.  Today we got her a glucometer of her own so she doesn't have to share mine.  Her bloodsugars were really good today.  But she had more dizzy spells and her blood pressure was too low even for a child.  So I might be jumping the gun with my thoughts of a diabetes diagnosis but her sugars were off before so something is up.  I'm glad that we'll start to see some of the specialists this week.  Hopefully they will help us to make some sense of all of this.

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Have you looked at the various forms of syncope for clues?

 

DD15 had an episode of 'hair-grooming syncope'.  I was flat ironing her hair and she fainted into my arms.  Long story short, she ended up at a cardiologist and had an echo on her heart.  The cardiologist diagnosed her and as odd as it sounds, the symptoms fit exactly.  

 

There are  few other forms of syncope that are related to hormones and anxiety.  

 

I don't doubt that her blood sugars are wonky, but they may not be the cause of the weakness/vision issue/migraine.  

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Tap, you are right that the blood sugar thing could be a totally separate thing.  And I think that is what the ped. thinks.  I think he probably will be amenable to revisiting the diabetes idea later on but right now he is pretty focused on cardiological/ neurological/ tumor (no -al ending there!) possibilities for her symptoms if even just for the reason of ruling them out.  The fact that her bloodsugars were better today in response to better diet, makes me feel better.  i guess all the other possible reasons are out of my control so I just focused on the one thing that I could control even a little bit and that is her bloodsugar.  

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You can also order your own lab test thru MyMedLab. You order and pay online and then go to a LabCorp facility for the blood draw. You get the results. I was very pleased with their service. There are other companies that do this, also (order your own tests), if you want to cost compare, etc.

 

Best wishes.

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I'd see a specialist.

 

I have PCOS, and am therefore insulin resistant to a degree.  As a high schooler, I barely crossed the 100 lb mark.  I was a long distance runner and had irregular cycles chalked up to the miles I put in and low body fat.  Years later, looking back, I had PCOS even then, but was not diagnosed.  As an adult, my BMI is around 21, so  not overweight.  I am still at risk of diabetes, take metformin to help with my cycles, and eat lower carb with a lot of paleo influence.  Healthy fats are great for getting enough calories in.  Avocado, full fat dairy (unsweetened greek yogurt), coconut milk, etc.

 

I'm not suggesting PCOS, but yes, thin, active people can still be at risk of diabetes and the like.

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Tap, you are right that the blood sugar thing could be a totally separate thing. And I think that is what the ped. thinks. I think he probably will be amenable to revisiting the diabetes idea later on but right now he is pretty focused on cardiological/ neurological/ tumor (no -al ending there!) possibilities for her symptoms if even just for the reason of ruling them out. The fact that her bloodsugars were better today in response to better diet, makes me feel better. i guess all the other possible reasons are out of my control so I just focused on the one thing that I could control even a little bit and that is her bloodsugar.

I think this is a good insight into your own thinking. The issues other than the blood glucose are much more worrying, and there is no reason yet to think they are related. While somewhat elevated bg's are concerning, they are not urgent. Perhaps keeping bg issues on the back burner until some of the other symptoms are addressed makes sense. Big hugs to you.
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I'm in the process of doing this.  This has all hit suddenly - actually a week ago yesterday.  She had complained some in the past of having her vision go dark when standing up but I figured it was the normal low blood pressure thing that you can get when you've been sitting for a long time.  Then a week ago, she had it happen while she was up and about and hadn't been sitting.  She said everything went dark, her legs got all wobbly and then she went into a migraine.  I should have tested her sugar then but had her eat and drink thinking she could be hypoglycemic and/or dehydrated and being focused on making her feel better, didn't think to test first.  She went to bed with an analgesic (which usually cures her migraines by morning) and she woke up still with a headache.  I took her bloodsugar then and her fasting sugar was 109.  Not a huge number but still not a normal fasting   So we tested all day and her numbers were off all day - again, not huge 200 plus numbers but in the 140 - 160 range after meals.  That's when I made the doctor's apointment for her.  But her file has a big red flag because of her tumor.  So all attention went to that as a possible cause of the symptoms and very little attention went to the bloodsugar readings because they weren't "bad enough".  So I've been busy making all the appointments to check her out neurologically etc. and been working on trying to monitor her sugars plus figure out meals so that we can see how she does with low carb.  Good thing we haven't started school yet!  

 

I thought this was a longer timeframe and that her tumor issues were a stable kind of thing since they were a known issue. And I would not have thought to test anything with a kiddo in crisis either. I got the impression you were seeing high blood sugars for quite some time and giving him specific instances of high numbers, which is why I thought charting might help.

 

Yeah, I can see the doc prioritizing. I don't know why ordering the blood test would have been a big deal, but he's focused on the tumor, so I'm sure he thinks the rest is just way less important. I do know that doctors seem to prefer to handle things over several visits (in some cases because of how billing works, and in some cases because one factor influences another).

 

I used to get wonky low blood pressure in college--it's not terribly fun. I didn't seek treatment since it seemed to resolve on its own, but blech. I hope she feels better soon. 

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I thought this was a longer timeframe and that her tumor issues were a stable kind of thing since they were a known issue. And I would not have thought to test anything with a kiddo in crisis either. I got the impression you were seeing high blood sugars for quite some time and giving him specific instances of high numbers, which is why I thought charting might help.

 

Yeah, I can see the doc prioritizing. I don't know why ordering the blood test would have been a big deal, but he's focused on the tumor, so I'm sure he thinks the rest is just way less important. I do know that doctors seem to prefer to handle things over several visits (in some cases because of how billing works, and in some cases because one factor influences another).

 

I used to get wonky low blood pressure in college--it's not terribly fun. I didn't seek treatment since it seemed to resolve on its own, but blech. I hope she feels better soon. 

The tumor is both a known variable and an unknown variable.  We've known about it for a couple of years.  It's been monitored.  But it is rare.  (As in we signed a release allowing them to use her as a case study at conferences and journal articles because they've never seen this in a child.)  So everything I hear about the tumor is something along the lines of "This should stay stable.  But let's check again in three months just to make sure."  Then as it seemed to truly be stable they lengthened the time between checks so it's been over a year since it was checked.  Now this.  It could be nothing at all to do with it but because it hasn't been checked recently and they really don't know, everyone has gotten uptight about it.  Including me. It doesn't help that they've never ever had an answer to my question of "What if it isn't stable?"  (it isn't something that could be just cut out because it involves blood vessels.)

 

I'm calming down.  I can see that I was overreacting about the blood sugar issue.  We're getting it under control with diet.  Which is what the doctor suggested when he gave me the carbs speech.  

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Jean--my experience as a mom of a kid who had a BT is that most non-neuro docs to jump on the "must be the BT" bandwagon....and the more rare the issue, the more likely it becomes.

 

Basilar migraines very, very often cause sight changes and dizziness.

 

Typically, if a pituitary tumor is causing diabetes--it's of the diabetes insipidus variety....not the blood sugar variety. ^DD^ developed DI when her brain tumor began to affect her pituitary gland, what your dd is going through doesn't sound like that.

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I think this is a good insight into your own thinking. The issues other than the blood glucose are much more worrying, and there is no reason yet to think they are related. While somewhat elevated bg's are concerning, they are not urgent. Perhaps keeping bg issues on the back burner until some of the other symptoms are addressed makes sense. Big hugs to you.

 

I think this is wise advice. 

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I have a DD with T1 diabetes. Just a thought, but illness can affect blood sugar. (so can stress, hormones, weather, the stars being out of alignment, etc) For us, because we're testing DD's blood sugar all the time anyway, it's easy for me to see how illness affects her. But I think that to some degree, illness could affect non-diabetic people as well. They just don't usually have a meter available or think to test themselves.  So I would think that other things going on with your DD could affect her blood sugar, so it's the other things you need to be worries about.

 

However, when a person develops Type 1 diabetes, their immune system is attacking their pancreas and destroying the beta cells that produce insulin. That process could take days, weeks or months. Most people only find out when their child becomes seriously ill and at that point nearly all of their beta cells have already been destroyed. On the diabetes forums I've read about several families who noticed the symptoms of T1 in their child very early on because they already had another child with T1.  Early on, their beta cells may be under attack, but they are still producing some insulin, just not enough to keep their blood sugar within "normal" range. You can't get an official diagnosis until their blood sugar or A1c is over a certain point, but some of those parents saw it coming months in advance.  

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Jean--my experience as a mom of a kid who had a BT is that most non-neuro docs to jump on the "must be the BT" bandwagon....and the more rare the issue, the more likely it becomes.

 

Basilar migraines very, very often cause sight changes and dizziness.

 

Typically, if a pituitary tumor is causing diabetes--it's of the diabetes insipidus variety....not the blood sugar variety. ^DD^ developed DI when her brain tumor began to affect her pituitary gland, what your dd is going through doesn't sound like that.

Thanks, Prairie.  I wish they knew more about the tumor so that I could get more firm information on what it should or should not do.  

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Jean--my experience as a mom of a kid who had a BT is that most non-neuro docs to jump on the "must be the BT" bandwagon....and the more rare the issue, the more likely it becomes.

 

Basilar migraines very, very often cause sight changes and dizziness.

 

Typically, if a pituitary tumor is causing diabetes--it's of the diabetes insipidus variety....not the blood sugar variety. ^DD^ developed DI when her brain tumor began to affect her pituitary gland, what your dd is going through doesn't sound like that.

Thanks, Desertblossom,  She's had some perfect sugars today and then some wonky ones,  Her bloodwork came back with some slightly elevated liver levels so she could be fighting something.  

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