June 30, 2003
Diagnosis and Symptoms
Question from Lowry City, Missouri, USA:
My almost eight year daughter has been on Glucophage XL for almost a year now to help with her weight. Her doctor ran a whole bunch of blood tests to try to figure out why she was rapidly gaining weight, and all of them came back within normal limits. He said that if there was any metabolic problem, the Glucophage would assist her in losing weight, which it has, but there is now a problem that I am worried about.
Four days ago, after having a healthy breakfast she was pale and shaky, and I was worried her blood sugar had dropped too low, so I used a friend’s glucose meter which showed her blood sugar was 218 mg/dl [12.1 mmol/L]. I re-calibrated the meter, ran the test again, and the sugar was 219 mg/dl [12.2 mmol/L]. I called her doctor who asked that I do trends over the next few days on her blood sugar.
Her fasting, two hour after breakfast, and two hour after dinner are all within normal range, but, each day, her two hour post lunch blood sugars have ran anywhere from 169-255 mg/dl [9.2-14.2 mmol/L]. I do not allow any sugary treats or snacks or drinks. Her doctor is at a loss as to what could be causing her blood sugar to raise in the afternoons as she takes her Glucophage with her breakfast.
Do you have any ideas as to what could be causing these raises? Should I be concerned? We have an appointment with a pediatric endocrinologist, however, it is not for a few months, and I don’t know if it will cause any permanent damage to wait until then to get these questions answered. Any help in this matter would be greatly appreciated.
Answer:
This is not normal. If she has normal fasting and premeal blood glucose values but clearly abnormal postprandial blood glucose values then she has clear glucose intolerance.
It is possible the Glucophage [metformin] dose should be increased or also possible she may need to be treated with insulin — or some combination. I would suggest calling the pediatric endocrinologist with whom she already has an appointment and talking directly either to the physician or the nurse working with this specialist. I suspect once they hear of these values they will arrange for your child to be seen sooner for a detailed evaluation.
SB
