Question from a nurse in Royston, Georgia, USA:

My four year daughter has been having frequent urination, is constantly thirsty and wants to eat all the time. Her fasting blood sugars are anywhere from 61 mg/dl [3.4 mmol/L] to 174 mg/dl [9.7 mmol/L] and 80-175 mg/dl [4.4-9.7 mmol/L] two to three hours after she has eaten. She complains a lot that she doesn’t feel good or that her head hurts, and when she complains, her blood sugar is lower than 60 mg/dl [3.3 mmol/L] or over 120 mg/dl [6.7 mmol/L].

We have done labs and her hemoglobin A1c is okay (5.1%), but her fasting insulin level is 2 (normal is 5-27). Her pediatrician was not concerned, but I asked to be referred because I feel something is not right. Is there anything else that can make her insulin level be low? Is there is their another explanation for her blood sugars being from one extreme to the other? Could she have diabetes? What are the diagnostic criteria?