Pre-diabetes aged 16 - advise please

[SJR]

Hello everyone, this is all new to me. My sixteen year old's blood test has come back with HbA1c at 44, type 2 pre-diabetic. His is slim and fairly fit, eats fairly healthily (always hungry at the moment which I put down to growing), no particular risk factors. The GP is in no particular hurry to get him checked again but I'm understandably worried. Seems to drink a fair bit and always cold. I think maybe GCSE mock exam stress is getting to him subconsciously over the last few months - can this cause a high HbA1c reading? Should I push for him to be reviewed again urgently? Should I inform his school? He's stopped asthma preventative medications as not needed, had covid a few years ago (with no symptoms) and had covid vaccinations. Any experiences and advise you are able to share would be gratefully received, thank you

 

[Pollyanna]

Hi ...

 

[Pollyanna]

Hi ...

Sorry ...fingers on go slow this morning...
Understandable you are worried...we always worry about them, especially at 'teen' stages.
I think if that had been one of mine I would be looking at a retest...there is so much going on at that age; peer pressure, school work, blazing hormones etc.
May I ask the reason for the blood test?
And I know it's a daft thing to say but please try not to worry, lots of experience on here 🙂

 

[SJR]

Sorry ...fingers on go slow this morning...
Understandable you are worried...we always worry about them, especially at 'teen' stages.
I think if that had been one of mine I would be looking at a retest...there is so much going on at that age; peer pressure, school work, blazing hormones etc.
May I ask the reason for the blood test?
And I know it's a daft thing to say but please try not to worry, lots of experience on here 🙂

Thanks yes - deep breaths! I do have knowledge of type 1 and devices as I work in marketing - working with pharma companies/HCPs launching CGM etc. but no experience on a personal level. He had problems swallowing last year so had thyroid tests, they thought it was thyroid inflammation due to infection but never really decided. We asked for another blood test as a first step to prehaps find out why he feels so cold all the time and purple hands (Reynaulds?) plus he seems have have low immunity and always got a cold/cough, not growing much etc. Hoping it's maybe hormones and exam pressures but I'm someone who likes to know every fact out there so gathering information. I did think about getting some finger prick tests done to monitor while we await GP appointment

 

[helli]

I'll start my answer with the huge caveat that I have no medical qualification.
To me, the prediabetes diagnosis for someone so young and not overweight looks suspicious so would be something that I would consider retesting.
Finger prick testing may give you some insights but only if you do them with a purpose and not randomly. For example, fasting tests first thing in the morning (as a baseline) or before and two hours after eating (to test the insulin response to carbs).

Regarding feeling cold and Reynauds, I am "lucky" to have both Type 1 and Reynauds. The Reynauds does not make me feel cold overall but when I am stressed (which may be due to cold but can also be a symptom of other things such as low blood glucose), my fingers go white (not purple) as the blood vessels contract restricting the blood flow. As the blood returns to my fingers, I often experience pins and needles.
From your very brief description, I am not sure your son's cold experience is the same.

The risk with Type 1 is that it can come on quite fast with youngsters so if he starts to experience any symptoms related to DKA (stomach pains, breathing problems, breath smelling like pear drops, ...), he should go to A&E.

 

[Pollyanna]

Yes...I would be finger pricking, my surgery gives out monitors to all but then I'm lucky, it maybe well worth your while investing in a monitor ( the shop on here sells them )
Test on waking, then before breakfast and 2 hours after....it is only a 'at that moment in time' reading but a good indicator.
Does he have a sweet tooth? Been over doing on the starch snacks such as crisps for example? What is his diet like in general? Is he a sport enthusiast... exercises well?
I have read that COVID and it's vacation can mess with blood glucose readings, colds sniffles etc and there is always the 'bugs' that flourish in a school environment and the hormones that are up and down at that age can certainly have an effect on blood glucose.
One of my great grandkids has Reynaulds, blue feet and hands, cold at night etc etc which the GP explained to his mum often starts in adolescence.
Just keep giving as much info as possible...I'm sure there will be others along soon to help.

 

[trophywench]

It isn't unheard of for someone that youthful to have 'pre diabetes' but because that usually precedes Type 2 diabetes, unless there is something in ethnicity (ie genes) or some other factor in the background at work - then it is definitely unusual for the reason that Type 2 diabetes does not usually occur in such a young individual.

What immediately strikes me is that the onset of Type 1 diabetes has very long (getting on for a century by now) been associated with having a viral illness - and what was/is Covid? Oh yes, a ruddy viral illness, previously unknown to humanity. Hence what I'd be wanting to do right now is to have at least one, if not further, blood tests to ensure that it is not the start of Type 1 diabetes.

The tests he needs to establish that are the HbA1c, C peptide and Antibody tests - the GAD Antibody and others too.

Presumably you or he can view all his test results via the NHS App so, is anything else 'a bit off' ? Plus, did they do a Full Blood Count - cos the results of a FBC can be very informative generally and various of them can indicate all sorts of different conditions apart from diabetes.

What is the GP saying is the next move?

 

[Inka]

I have Raynauds too @SJR but I don’t always feel cold. That sounds more like the kind of thing associated with thyroid issues - and I see you’ve mentioned those. If it were my child, I be asking for a repeat HbA1C, a thyroid test(if not done) and some other general tests like liver, kidney, ferritin, etc etc (if not already done).

Buying a fingerprick glucose meter is a good idea. I’d also consider buying a pot of Ketostix (approx £5) because, like others, I’d be nervous of Type 1. I’d also weigh him and keep an eye out for any weight loss.

 

[SJR]

Yes...I would be finger pricking, my surgery gives out monitors to all but then I'm lucky, it maybe well worth your while investing in a monitor ( the shop on here sells them )
Test on waking, then before breakfast and 2 hours after....it is only a 'at that moment in time' reading but a good indicator.
Does he have a sweet tooth? Been over doing on the starch snacks such as crisps for example? What is his diet like in general? His he a sport enthusiast... exercises well?
I have read that COVID and it's vacation can mess with blood glucose readings, colds sniffles etc and there is always the 'bugs' that flourish in a school environment and the hormones that are up and down at that age can certainly have an effect on blood glucose.
One of my great grandkids has Reynaulds, blue feet and hands, cold at night etc etc which the GP explained to his mum often starts in adolescence.
Just keep giving as much info as possible...I'm sure there will be others along soon to help.

Thanks 🙂 Not particularly an OTT sweet tooth but he's always looking for food at the moment and I guess sneaks in sausage rolls, choc bars, tin of rice pudding, yogurts after school and after dinner. No so much crisps. Hands up we could probably healthier as they all like 'man meals' but rarely eat ready meals and buy lean meat and have fresh fruit and veg. He'll fairly active although revision taking over at the moment - runs when light evenings with his brother once a week, dog walks, is in the army cadets with PT but school PE has stopped now which is a shame. I read Reynaulds can be hormones - hopefully everything will sort itself!

 

[SJR]

I have Raynauds too @SJR but I don’t always feel cold. That sounds more like the kind of thing associated with thyroid issues - and I see you’ve mentioned those. If it were my child, I be asking for a repeat HbA1C, a thyroid test(if not done) and some other general tests like liver, kidney, ferritin, etc etc (if not already done).

Buying a fingerprick glucose meter is a good idea. I’d also consider buying a pot of Ketostix (approx £5) because, like others, I’d be nervous of Type 1. I’d also weigh him and keep an eye out for any weight loss.

Thanks, thyroid and all bloods fine apart from HbA1C and serum albumin was 53 - but they had trouble getting blood from him which I think can raise the level. I've submitted his content to speak to GP on his behalf so will try again for an appointment tommorrow

 

[SJR]

I'll start my answer with the huge caveat that I have no medical qualification.
To me, the prediabetes diagnosis for someone so young and not overweight looks suspicious so would be something that I would consider retesting.
Finger prick testing may give you some insights but only if you do them with a purpose and not randomly. For example, fasting tests first thing in the morning (as a baseline) or before and two hours after eating (to test the insulin response to carbs).

Regarding feeling cold and Reynauds, I am "lucky" to have both Type 1 and Reynauds. The Reynauds does not make me feel cold overall but when I am stressed (which may be due to cold but can also be a symptom of other things such as low blood glucose), my fingers go white (not purple) as the blood vessels contract restricting the blood flow. As the blood returns to my fingers, I often experience pins and needles.
From your very brief description, I am not sure your son's cold experience is the same.

The risk with Type 1 is that it can come on quite fast with youngsters so if he starts to experience any symptoms related to DKA (stomach pains, breathing problems, breath smelling like pear drops, ...), he should go to A&E.

Thanks for replying, he's stressed with exams at the moment and I'm sure raging hormones with his age - a number of factors to consider!

 

[SJR]

It isn't unheard of for someone that youthful to have 'pre diabetes' but because that usually precedes Type 2 diabetes, unless there is something in ethnicity (ie genes) or some other factor in the background at work - then it is definitely unusual for the reason that Type 2 diabetes does not usually occur in such a young individual.

What immediately strikes me is that the onset of Type 1 diabetes has very long (getting on for a century by now) been associated with having a viral illness - and what was/is Covid? Oh yes, a ruddy viral illness, previously unknown to humanity. Hence what I'd be wanting to do right now is to have at least one, if not further, blood tests to ensure that it is not the start of Type 1 diabetes.

The tests he needs to establish that are the HbA1c, C peptide and Antibody tests - the GAD Antibody and others too.

Presumably you or he can view all his test results via the NHS App so, is anything else 'a bit off' ? Plus, did they do a Full Blood Count - cos the results of a FBC can be very informative generally and various of them can indicate all sorts of different conditions apart from diabetes.

What is the GP saying is the next move?

Thanks, I'm going to try to get an 'emergency' appointment with GP tomorrow to discuss further. A teenage relative was diagnosed with type 1 last year (my husband's cousin's son - is that second cousin? Grandad's were brothers). All bloods were OK apart from serum albumin - 53. I'll look back to see what else he was checked for last year.

 

[helli]

Thanks for replying, he's stressed with exams at the moment and I'm sure raging hormones with his age - a number of factors to consider!

It is easy for those of us with diabetes on this forum so get hung up on the many factors (such as stress) which can raise our BG. However, if your insulin/pancreas is behaving itself, the body will release insulin to ensure the BG rise is small.
To my understanding, stress will only cause a higher HBA1c if he has "diabetes related" issues.
There are situations where HBA1c can be unreliable such as (but not restricted to) anaemia and sickle cell.

 

[SJR]

Interesting re anaemia, I'll have to check if his blood was checked for this. Thank you x

 

[Pollyanna]

Thanks 🙂 Not particularly an OTT sweet tooth but he's always looking for food at the moment and I guess sneaks in sausage rolls, choc bars, tin of rice pudding, yogurts after school and after dinner. No so much crisps. Hands up we could probably healthier as they all like 'man meals' but rarely eat ready meals and buy lean meat and have fresh fruit and veg. He'll fairly active although revision taking over at the moment - runs when light evenings with his brother once a week, dog walks, is in the army cadets with PT but school PE has stopped now which is a shame. I read Reynaulds can be hormones - hopefully everything will sort itself!

PE has stopped? Is that temporary....I thought it was on the national curriculum.
I would definitely start finger pricking and ask for a retest but in the meantime I would be encouraging one of mine to cut down on the carbs a bit, both the simple carbs, the sugars and complex carbs, the starches. Tinned rice pudding sounds very high carbs. When it comes to fruit then berries are the best to eat, especially blueberries. Knowing full well what they like at that age (a Nana's role is often as mediator🙂 ) I wouldn't be 'nagging' but just pushing in the right direction...if you look on the Keto shop there are snacks and there are plenty of low carb pastas these days.
When eating carbs we try to slow down the digestion process so we don't get sugar spikes. We do this by adding more fibre to what we eat...so green leaf veg for example or low fat yoghurt with berries and nuts. We all react differently to different food groups too. So I can eat grapes by the dozen with no problem but give me melon and I'm on a sugar high.
There is lots of dietary info on here...I'm not good at linking stuff but there are some pinned threads on the front pages.

 

[Robin]

I personally don’t think that restricting carbohydrate in a growing lad who probably doesn’t have Type 2 diabetes is appropriate.
If he’s eating a lot, he’s either having a growth spurt and needs the energy from the food he’s currently eating , (or if he does turn out to be beginning to develop Type 1 diabetes, his body may not be able to use all the energy he’s consuming). There may be a case for limiting sugary snacks with empty calories for all of us, but complex carbohydrates are exactly the things he needs to be eating as part of a balanced diet.
The last thing you want to do, @SJR, is make an issue of food, or eating. If his insulin production is actually fine, it will be coping with the carb that he’s eating, and if his insulin production is failing, cutting carbohydrate may mask this, and lead to a delayed diagnosis.

 

[Pollyanna]

I personally don’t think that restricting carbohydrate in a growing lad who probably doesn’t have Type 2 diabetes is appropriate.
If he’s eating a lot, he’s either having a growth spurt and needs the energy from the food he’s currently eating , (or if he does turn out to be beginning to develop Type 1 diabetes, his body may not be able to use all the energy he’s consuming). There may be a case for limiting sugary snacks with empty calories for all of us, but complex carbohydrates are exactly the things he needs to be eating as part of a balanced diet.
The last thing you want to do, @SJR, is make an issue of food, or eating. If his insulin production is actually fine, it will be coping with the carb that he’s eating, and if his insulin production is failing, cutting carbohydrate may mask this, and lead to a delayed diagnosis.

Yep...fair comment

 

[Drummer]

When mine were that age I was supplying protein - with the fats naturally associated with eggs, cheese, meat and fish - that is what builds a growing body and the raw materials for hormones and other controls, enzymes - and the nervous system too.
I have two fridges and the food in one of them was freely available, and already cooked ready to eat - it seemed the sensible option.

 

[Inka]

Yep...fair comment

Yes. Not only is it not necessary, it inadvertently plays into the commonly repeated myth that Type 1 is caused by sugar. When I was a young child of about 4yrs old, a woman told me off for eating a sugar lump and said that I’d get diabetes. Then, after getting Type 1 - which was nothing to do with eating sugar lumps!! - another person told me I must have eaten too many sweets 🙄

To be clear, Type 1 is an auto-immune condition.

Good luck @SJR Let us know how things go.

 

[Thebearcametoo]

It’s an incidental finding and one reading on a kid who isn’t overweight so I wouldn’t get too worried at the moment. Do another test in 3 months and see what that says. And in the meantime keep an eye on his drinking habits and if he’s always thirsty and needing to get up in the night to pee when he doesn’t normally then go back to the GP.