D2 MTE3 Case 8: Diagnosing diabetes mellitus in children

An eight-year boy. Height: 134.9 cms. Weight: 47 kgs. BMI: 26 kg/m(2)Positive Family history of T2DM (mother). Pubertal status: A1, P1, TV 3 ml bilateral. No signs of insulin resistance. No osmotic symptoms. RBS: 284 mg/dl. Blood 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 mcg. Calcium 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 diagnosis. Below normal C-peptide with highly elevated GAD suggested some beta cell dysfunction. Line of treatment?