Abstract
An eight-year boyHeight: 134.9 cmsWeight: 47 kgsBMI: 26 kg/m2Positive Family history of T2DM (mother)Pubertal status: A1, P1, TV 3 ml bilateralNo signs of insulin resistanceNo osmotic symptomsRBS: 284 mg/dlBlood ketones: 0.1 mmol/l. Laboratory investigation:Reports revealed Fasting blood sugar 130 mg/dl with HbA1c 7.4% and TSH 42.63 μIU/ml. He was advised the following treatment: Levothyroxine 75 mcgCalcium and vitamin D On follow up visit after 30 days and 60 days. Fasting blood glucose readings were ranging between 95-221 mg/dl and Post prandial 96-396 mg/dl. C-peptide 1.12 ng/ml (2 hours post meal) and Serum GAD 65 IgG (IU/ml) >2000. After thyroid hormone replacement TSH came down to 4.11 (μIU/ml). No significant finding in abdominal ultrasound. Points to ponder: Inconclusive diagnosisBelow normal C-peptide with highly elevated GAD suggested some beta cell dysfunction.Line of treatment?
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