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July 4, 2002

Diagnosis and Symptoms

Question from Joplin, Missouri, USA:

A a few weeks ago, I asked a question and now have new information I need some help with. My 11 year old daughter has had symptoms of diabetes (extreme thirst and urination; failure to gain weight) for about six weeks now. After her pediatrician ruled out diabetes type 1 and diabetes insipidus, she continued to have the symptoms so I purchased a cheap home meter and started checking her blood sugar every few days. I know you are not supposed to use these for diagnosis, but I was at a loss as to what to do next. She has had one fasting morning reading of 160 mg/dl [8.9 mmol/L], and a two hour after breakfast reading of 205 mg/dl [11.4 mmol/L]. Several days of normal readings went by (with only an occasional 140-170 mg/dl [7.8-9.4 mmol/L] reading after eating). Then she had a 231 mg/dl [12.8 mmol/L] one evening, about three hours after eating. I took all these numbers to her pediatrician who still is positive she doesn't have type 1 diabetes, based on the fact that she has not tested positive for urine sugar and fact that some days, her blood sugar is normal all day and always returns to normal even after these high numbers. Could this possibly the beginning of her pancreas failing? Should I insist on seeing a specialist? What should I do now? Her pediatrician said just to "watch her". Please help!

Answer:

As you already alluded to, the use of the home glucose meter is not ideal to make a diagnosis of diabetes. However, I think your daughter’s physician was incorrect when stating this can’t be diabetes (type�1 or type�2) based on negative glucose in the urine.

Could this be the signaling of a “failing pancreas?” Yes, could be. It seems to me that the way to best address this would involve scheduling your child for a venipuncture glucose level and even a two-hour postprandial level. In addition, while I do not think there are frequent times when a formal oral glucose tolerance test (OGTT) is required, this may be one of those times. However, there are strict criteria and directions in properly performing an OGTT so if this is done, best it be done correctly:

The patient must consume at least 60% of all calories during the three days leading up to the test as carbohydrates.
A very specific glucose load is prescribed (1.75 grams of dextrose per kilogram body weight) to a maximum of 75 grams).
Measure glucose and insulin at the prescribed times.

One might even consider doing special pancreatic antibody testing for type 1 diabetes.

My bias is that a specialist may be able to reassure or confirm a diagnosis for you. There are many other entities that can lead to increased urination but have no relation to blood sugar.

DS