My six year old son has had type 1 diabetes for two and a half years. We periodically check the rest of our sugars. My daughter, who just turned two, recently had some blood sugars just over 200 mg/dl [11.1 mmol/L]. She had some symptoms of diabetes such as hunger, thirst, and frequent urination. Her fasting sugars were normal. Her A1c was 5.4%. She was not ill at the time. For the past week, the highest blood sugar I have gotten for her was 163 mg/dl [9.1 mmol/L]. Could this be the early stages of diabetes? At this point, I am supposed to just watch her for symptoms and monitor her a few times per day.

I understand your concern and you are justified. I don’t have a real problem with the advice you’ve been given to monitor her, BUT the various glucose monitors for home use are not at all intended nor sensitive enough to best establish a diagnosis of diabetes. There are too many variables and the equipment is not fine enough. If you HAVE diabetes, and the glucose level is in actuality 300 mg/dl [16.7 mmol/L], but the meter gives a reading of 220 mg/dl 12.2 mmol/L], then the discrepancy is bothersome, but nevertheless, the value is still “high.” If you DON’T truly have diabetes and your glucose is 100 mg/dl [5.6 mmol/L] (normal) but the reading is 160 mg/dl [8.9 mmol/L], it gives you a false diagnosis.

Certainly her symptoms of increased thirst and urination are concerning, especially with the higher readings. I think she needs some fasting levels and maybe some readings two hours after meals. But, if there are real questions, she needs a blood draw from a vein run in your hospital’s laboratory.

And PLEASE remember (although many physicians do not) that an A1c test is NOT a good test to screen for diabetes. It reflects glucose levels over the course of the previous two to three months, on average, and is impacted by the glucose levels (on average) plus the quantity/quality of the hemoglobin. To diagnose diabetes or glucose intolerance or impaired fasting glucose, you need to measure serum glucose levels from the vein at a laboratory.

DS