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September 30, 2008

Diagnosis and Symptoms, Hyperglycemia and DKA

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Question from Wilton, Connecticut, USA:

My daughter has type 1. This morning, my brother took his two-year-old daughter to the doctor and her blood sugar was 340 mg/dl [18.9 mmol/L] after a cup of milk. The pediatrician sent them to the hospital where she has had normal sugars after eating two meals. She was sent home from the hospital. They seem to think the equipment in the doctor’s office was faulty or miscalibrated. The blood work will all be back on Tuesday and they’ll know for sure then. The doctor did not do a urine analysis like they did when my daughter was diagnosed. My brother did say that she’s been drinking a lot and, for a few nights, she peed out of her diaper which were my daughter’s initial symptoms. He seems to think the excess drinking is due to a lack of staff at her day care so she’s not getting enough fluids during the day.

My daughter was diagnosed at the same age as my niece is now by the same pediatrician. We also had a normal reading when we first arrived at the hospital, but, after a meal, she was quite high and we were admitted during the week so all the laboratories were open and able to process her blood work pretty quickly.

I have my fingers crossed. Is it possible to have an isolated high blood glucose reading? Could this be a sign of pre-diabetes?

Answer:

From: DTeam Staff

Yes, it is possible for a patient “on the brink” of diabetes could have an isolated high glucose. But, a value of 340 mg/dl [18.9 mmol/L] is pretty high just to be “isolated.” It is much more likely that the doctor’s office measured the glucose with a home glucose meter. These meters, as you know, must periodically be calibrated and used with control solution, and have codes aligned with strips (for those meters that require this) in order to function well. And, they do become “old.” In my experience, private practice doctors RARELY keep up any quality assurance methods on their glucometers. So, hopefully, the hospital laboratory values were reassuring. Nevertheless, given the family history and the child’s symptoms, I’d still have you all be on the look out and have a low threshold to test for this again. I do agree that it would have added something for the doctor to have checked the urine, but having said that, blood tests are (typically) more accurate.

DS