December 22, 2004
Diagnosis and Symptoms
Question from Haworth, New Jersey, USA:
Since we were moving from the United Kingdom to the United States in mid-October, we took our daughter for a routine check-up for school. At the examination, her urine was very positive for sugar. We went back the following day for fasting blood sugar level. Her urine level was okay; her blood sugar was 246 mg/dl [13.7 mmol/L]. We were sent to the Emergency Room (ER), where all the results were okay. She consumed a can of Coke, followed by a blood sugar of 84 mg/dl [4.7 mmol/L] one hour later.
We were sent home by ER doctor with everything fine. The pediatric endocrinologist telephoned us the following evening and was concerned because the A1c was 5.6%. We were left with the distinct impression that our daughter was pre-diabetic. Our family doctor is also of that opinion. They are not 100% convinced she has pre-diabetes, nor are they 100% sure she is not. However, the head of the diabetic unit at hospital has also phoned and asked us to see him in four months. In his opinion, she isn’t diabetic.
So, what’s going on? Is she or isn’t she diabetic. Should we be doing anything? Can we do anything? Can stress cause the high blood sugar? Our daughter went to the dentist was very nervous and this was followed by doctors for three vaccines. She has phobia about needles!
If you think it is early signs of diabetes, is there anything we can do to slow it progression? Should we monitor our daughter or not?
Answer:
The story, though not typical indeed, of your daughter, might suggest a true type 1 diabetic state more than a pre-diabetic phase as a fasting blood sugar level as high as 246 mg/dl [13.7 mmol/L] is diagnostic when double-confirmed, with or without sugar in the urine, of clinical diabetes 100% of the times. If fasting blood sugar levels are currently within normal values and no sugar in the urine is found, then, to rule out any doubt, I’d suggest the following diagnostic procedures: autoantibodies such as GADA, IA2 and IVGTT eventually followed by OGTT if the IVGTT is abnormal.
I do not think that stress or vaccines could have had any role towards the causation of her suspected diabetes nor something can be actually done to slow its progression. Regarding monitoring of your daughter, if all the previous procedures are negative for diabetes, I suggest no further follow up.
MS
