November 23, 2002
Diagnosis and Symptoms
Question from Central City, Nebraska, USA:
My six year old daughter was vaguely diagnosed with early diabetes, treated with diet only. She has a lot of normal blood sugar but also goes high ( 200-400 mg/dl [11.1-22.2 mmol/L], and her A1c is 4.8%. Her endocrinologist says to leave her be and not to check her blood sugar, but to let it progress since she has so many normal blood sugar that insulin would cause her to go low. I don’ t like him because he never gives me satisfying answers, patronizes me, and tells me that it’s harder on me than on the child.
My daughter wets her bed and occasionally during the day. Upon my insistence, after she had blood sugars of 260 mg/dl [14.4 mmol/L], 235 mg/dl [13.1 mmol/L],182 mg/dl [10.1 mmol/L], and 392 mg/dl [21.8 mmol/L] in one day, her wonderful pediatrician put her in the hospital for a three-hour glucose tolerance test. She had 35 grams of the drink,. her blood sugar peaked at 175 mg/dl [9.7 mmol/L], and, at the third hour, she dropped to 41 mg/dl [2.3 mmol/L].
After conferring with the endocrinologist, I am told she had reactive hypoglycemia and does not have diabetes. How can this be? After checking her blood sugar routinely for six, months she has never had more than four blood sugars under 70 mg/dl [5.9 mmol/L] and has far more over 120 mg/dl [6.7 mmol/L].
I.m told to no longer check her blood sugar, and we changed her diet, but I am still concerned because surely high blood sugars are not normal. I have asked for a ultrasound of the pancreas. Is there any thing else that should be done? I feel so helpless, and I don’t feel comfortable with this new diagnosis. Are there other tests I can request? Would a second opinion be justified?
Answer:
Sounds like you need another opinion. This could all be a case of evolving pancreatic beta cell demise or a slow onset version. Sometimes this is seen in overweight/obese children. Unfortunately, the data you provided does not allow a clear diagnosis. Islet cell and GAD 65 antibodies as well as insulin antibodies may help to determine if this is an autoimmune type of diabetes. I’m not sure if HLA antigen typing would help here at all.
Your daughter’s endocrinologist is probably correct that insulin treatment is not such a sure correction since there are episodes of low sugars as well as high sugars. In either case, close observation (ongoing monitoring of blood glucose levels) will help to decide what, if anything, one needs to do.
It’s unlikely that pancreatic ultrasound or other imaging would help. Time may help figure out what else needs to be done depending upon hemoglobin A1c levels and actual blood glucose changes.
SB
