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October 23, 2009

Diagnosis and Symptoms

Question from Jonesboro, Georgia, USA:

This question is concerning all three of my children. While at the pediatrician with my oldest daughter (8eight years old), I mentioned that she was drinking and urinating a ton, while not eating very well. She had also been complaining of headaches and stomach aches. The doctor tested her glucose, which was 131 mg/dl [7.3 mmol/L]. She asked me had she eaten. I told her she had only taken her Adderall with a half teaspoon of applesauce, followed by only a sip of juice and she wouldn’t eat breakfast. This had been about four hours or more before her appointment/glucose test. So, she wanted me to take her back for a fasting test early the next morning. Her fasting level was 118 mg/dl [6.6 mmol/L], which still concerned the doctor. She referred us to an endocrinologist.

Since my six-year-old daughter had an appointment the next morning, I went ahead and had her and my two-year-old son fast that night. All of my kids drink like crazy and, of course, urinate a lot, too. They tested them both the next morning. My daughter was at 122 mg/dl [6.8 mmol/L] fasting and my son was 116 mg/dl [6.4 mmol/L] fasting. Now, all three have been referred to the endocrinologist. I wasn’t all that freaked out until we had another visit a few days ago and the pediatrician was upset that we had not been able to get an endocrinologist appointment yet. She seemed really bothered and said that we couldn’t “sit on this for long” and planned to call the endocrinologist herself. She told me to cut out their sugar and I’ve been doing the best I can with little information to go on. My specific questions: Are these levels indicative of diabetes? If not, what could they mean? Why would all three of my children have high glucose levels? Is this normal? Have I done something?

The common denominators are this: I had preeclampsia with all of my pregnancies. They all three have asthma and the oldest has ADHD. Other than my grandfather, who died with diabetes, there is no other history on either side that we’re aware of. My random glucose is usually around 78 mg/dl [4.3 mmol/L], while my husband’s tends to be low, in the 60s mg/dl [3.3 to 3.8 mmol/L]. Thanks in advance for your assistance. We’re still anxiously awaiting the endocrinologist appointment and it’s hard to wait for answers!


From: DTeam Staff

We have many questions about the Diagnosis and Symptoms of diabetes. Please refer to some of those questions.

In short, the interpretation of these tests hinge a lot on how the glucose levels were obtained. If they were measured using a small, portable glucose meter using a single small drop of blood (with an answer within about 1 minute), then I am less concerned. Such devices have about a 20% error rate meaning the value obtained could be off by near 20% (higher or lower). Furthermore, if the device has not been calibrated or properly “coded” (some older meters still require this). then the values could be further inaccurate. On the other hand, if the values you shared were from a blood sample from a vein and analyzed in a formal laboratory, then these values have some more meaning to me.

A fasting serum or plasma glucose level (from a vein, run in the laboratory) is normally about 60 to 100 mg/dl 3.3 to 5.6 mmol/L]. A value of 126 mg/dl [7.0 mmol/L] or more is consistent with diabetes mellitus. A value between 100 and 125 mg/dl [5.6 and 7.0 mmol/L] is consistent with an entity often referred to as impaired fasting glucose – which is sort of a “pre-diabetes” stage but potentially reversible.

It would be unlikely (but not impossible) for all three of your children to have type 1 diabetes. There are some rather rare inherited types of diabetes mellitus but without you or your spouse having diabetes, these would be unlikely.

I am surprised that your pediatrician did not give you more specific instructions if she is so concerned! While the values you gave or worthy of follow up, perhaps even with a pediatric endocrinologist now, they are not “dangerous” at these concentrations and I believe that your pediatrician is not correct to be “really bothered” and not wanting to “sit on this”.

Your preeclampsia during your pregnancies had nothing to do with these glucose levels.

Are your children chunky? Are they active? Do they eat much “junk” food or are there diets genuinely healthy and well rounded (vegetables, milk, limited juices/fruit drinks/sodas)? While you wait for the appointment with the pediatric endocrinologist, ask your pediatrician to send you to a Certified Diabetes Educator (CDE) who can teach you some proper techniques to check some glucoses at home with a properly formatted glucose meter (for each child) and also some dietary instructions. IF (and I mean IF) your children do have diabetes, then it has been discovered early and some visits with a CDE will only benefit you and be able to provide the pediatric endocrinologist with additional information. If the children do NOT have diabetes, the CDE consultation will serve to help distinguish this.

Good luck and please let us know what you learn!