December 9, 2005
Diagnosis and Symptoms
Question from Granville, New York, USA:
My 10 year daughter was having symptoms of high blood sugar and, at times, hypoglycemia. I bought a meter and her blood sugars are over 200 mg/dl [11.1 mmol/L] at times. She also has had blood sugars as low as 64 mg/dl [3.6 mmol/L]. Her regular doctor did blood work and her A1c was 5.9 while her cholesterol level was 213. She was referred to an endocrinologist who did a Glucose Tolerance Test (GTT) that was normal, 98 mg/dl [5.4 mmol/L] fasting and 107 mg/dl [5.9 mmol/L] at two hours. Her insulin levels were not done.
At home, her fasting blood sugars are between 100 and 110 mg/dl [5.6 and 6.1 mmol/L]. She was wetting the bed and had two viral UTIs during which her fastings were 130 to 140 mg/dl [7.2 to 7.8 mmol/L]. She is due to be seen by her pediatrician and I was wondering what tests should be done to figure have type 1. Three out of four of her grandparents have type 2 and I had gestational diabetes.
Answer:
I am not sure that I would do anything. Assuming that the Oral GTT was done properly, then diabetes has been excluded, for the time being. I am disappointed that insulin levels were not measured during the OGTT.
The hemoglobin A1c is not good way to diagnose diabetes. It is a good tool to continue to assess glucose control in someone with verified diabetes.
There is no way to prevent type 1 diabetes, but there are research programs. Given the family history of the cousins and uncles with type 1 diabetes, this patient MIGHT be a candidate to participate in TrialNet. Ask you pediatrician or endocrinologist or search the Internet for participating centers.
DS
