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November 28, 2007

Diagnosis and Symptoms

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Question from Kansas, USA:

For at least the past three years, we have observed our son experience what we thought was a low blood sugar. His personality would change drastically; he would become defiant or refuse to talk. He often stared off and seemed to be in what we called “the zone.” He is often extremely hungry to the point that he shuts down and won’t answer questions. He complains about his legs being tired or that he is thirsty. He is very thin but eats all the time.

We finally went to see an endocrinologist and, due to his initial readings on a home glucose monitor that actually indicated his blood sugar was high not low, we went for a three hour glucose test. He passed this test and there were no signs to indicate he has diabetes.

The endocrinologist suggested we monitor him two hours after dinner for two more months. Here are some of his readings two hours after dinner: 225 mg/dl [12.5 mmol/L], 179 mg/dl [9.9 mmol/L], 145 mg/dl [8.1 mmol/L], 163 mg/dl [9.1 mmol/L], 302 mg/dl [13.8 mmol/L], 194 [10.8 mmol/L], and 280 mg/dl [15.6 mmol/L]. His highest reading has been 346 mg/dl [19.2 mmol/L]. Are these readings high for a seven-year old? Would these reading indicate he might have type 1 diabetes? How was he able to pass the three hour glucose test? We are worried about what he is doing to his body. We have yet to receive an answer to why we have these readings. He is not on medication and has not been diagnosed with diabetes.

Answer:

From: DTeam Staff

The readings after dinner are irregular, but a lot hinges on proper technique:

Are the blood stick sites clean and dry before poking?

Is the meter properly “coded?” Some meters require coding to match the strip with the meter; some newer meters do not.

It would be helpful to know the complete details and results of the three hour glucose tolerance test. Was the patient properly prepared in terms of diet the three days preceding the test? Was the proper glucose load given at the time of the test? Were glucose and insulin values measured during the test?

Is there a family history of diabetes? A somewhat uncommon form of diabetes (called “MODY-2”) could present this way. I think you should maintain your dialogue with the pediatric endocrinologist. If the endocrinologist your child has seen is NOT a pediatric sub-specialist, you might strongly consider a referral.

DS