July 21, 2010
Diagnosis and Symptoms
Question from Nashville, Tennessee, USA:
I can't tell you how much I need your assistance. My 13-year-old daughter, who is highly active in a competitive sport, 5 feet, 5 inches tall and 117 pounds (down from 125 pounds), has been experiencing weight loss, stomach pains, nausea, dizziness, wanting to eat sugary foods, infrequent severe headaches, and has had episodes of almost passing out. In addition, she had "chest pain" but a cardiologist said nothing was wrong; it turned out to be more of shortness of breath. The doctor thought she might have an ulcer because of the persistent stomach pain and eating helped her feel better. Two Emergency Room visits have resulted in being sent home on Zantac and I have no idea what the tested for when they tested her blood. I have looked up the symptoms and come up with many possibilities because this remains unresolved. She is going to a gastroenterologist on Friday, but for all we know, it is will be a part of eliminating that it is not a true stomach issue but a symptom. When I read about possible bed wetting (which happened a few weeks ago and had not happened since she was a toddler), and the other symptoms, I thought maybe this would be an avenue worth exploring. What do you think? Are there other "subtle" symptoms that may seem insignificant if they are experienced as a stand alone, but, put in context, could point to diabetes? Her dad has diabetes and so did his deceased mother. I hope you can give me some insight as her quality of life has declined and, clearly, something is wrong. Last, but not least, is there such a thing as a false negative if tested for diabetes as a child?
I think that having your child assessed by a pediatric gastroenterologist is a good idea. Among the condition that professional may discuss with you is “celiac disease.”
The “subtle” symptoms “could” point to diabetes. Nevertheless, “common things happen commonly.” A 13-year-old having recurrent of bed wetting is of interest, but common symptoms of diabetes mellitus also include increased urination during the daytime and increased thirst. Although weight loss can be a symptom of diabetes mellitus, MANY OTHER things can lead to weight loss. Has your general pediatrician looked for a urinary tract infection? Increased calcium in the urine? In the vast majority of cases of diabetes mellitus, there is not a “stand alone” symptom but rather a constellation of several symptoms..
I gather that some time in the past, your daughter was screened for diabetes mellitus and was found to NOT have it (“tested negative;” i.e., her glucose levels were not elevated) and now you wish to know if that test could have been in error and that she actually genuinely had diabetes (thus the first screen was a “false negative”). The answer is that ALL tests have “false negatives” (as well as “false positives”), but if your daughter actually had diabetes mellitus years ago, she would not have gone then undiagnosed for years later. So, the answer to your specific question regarding YOUR daughter is a strong “probably not!” There are other specific screening tests for “risk of diabetes,” which, in general, are a series of pancreatic antibody tests, that also can evolve, i.e., can indeed be negative but later become positive. Furthermore, one can have a pancreatic antibody and NOT develop diabetes mellitus, as such antibodies are a risk factor only. (Similarly, to put this in perspective, you might smoke cigarettes – a risk for lung cancer – but never develop lung cancer. Also, you could develop lung cancer but never have smoked.),