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September 15, 2007

Diagnosis and Symptoms

Question from Auburn, Washington, USA:

My 11-year-old daughter went in for a routine sports physical last week. They took a urine sample and found sugar in it so they did a finger prick test and it measured 236 mg/dl [13.1 mmol/L]. She had thrown up or had the flu the night prior. The doctor suggested we take her to an endocrinologist, which we did the following Thursday. We were sent with no information about what to expect. When we got there, my daughter was again finger pricked and tested at 160 mg/dl [8.9 mmol/L]. The doctor came in and said she had type 1 diabetes. We then were sent to the laboratory for a blood draw and urine sample. After that, we had to wait some time for the educator to come give us information. We went across the street and my daughter ate some scrambled eggs, one piece of bacon, one-half of a piece toast and some milk. When we finally did get to see the educator, she was showing us how the meter worked and my daughter's blood sugar tested at 87 mg/dl [4.8 mmol/L]. The educator then looked confused at how low the reading was. She asked the doctor about it, but he said to go forward with the information on the meter and the insulin pen. After going through all the information with the educator, we left, but a mother's gut feeling can be very strong and I left the appointment not feeling so good about the diagnosis. My husband and I decided that evening we wanted to get a second opinion and really find out on what the doctor had based his decision. My daughter has no other signs of having diabetes (no constant urination, thirst or blurred vision). Below are some results from the last five days of meter reading and ketone testing. Because of the holiday weekend, we have not gotten laboratory results, but are curious as to what protocol is for making such a diagnosis. And, if we start our daughter on insulin, are there instances when they are taken off of insulin? Home glucose tests: Date Time Blood Glucose August 30 fasting 162 mg/dl [9.0 mmol/L] August 30 after breakfast 87 mg/dl [4.8 mmol/L] August 30 evening 133 mg/dl [7.4 mmol/L] August 31 8:30 a.m.(fasting) 92 mg/dl [5.1 mmol/L] August 31 8 p.m. (after dinner) 130 mg/dl [7.2 mmol/L] September 1 9:20 a.m.(fasting) 87 mg/dl [4.8 mmol/L] September 1 3:10 p.m. (after lunch) 71 mg/dl [3.9 mmol/L] September 1 7:15 p.m. (after dinner) 130 mg/dl 7.2 mmol/L] September 2 9:15 a.m. (fasting) 96 mg/dl [5.3 mmol/L] September 2 9 p.m. (after dinner) 122 mg/dl [6.8 mmol/L] September 3 10 a.m. (fasting) 111 mg/dl [6.2 mmol/L] September 3 7:10 (before dinner) 103 mg/dl [5.7 mmol/L]


It sounds like early diabetes diagnosis. It is almost impossible to have such high blood sugar levels without insulin deficiency of one kind or another. Obesity can be a factor. Type 1 diabetes in kids is thought to be an autoimmune disorder, so probably your doctor ordered special antibody tests (islet cell, GAD-65 and insulin antibodies). This will help make the diagnosis, if positive; but they can be negative about 20 to 40% of the time and so, unhelpful, if negative. Family history of autoimmune endocrine disorders also may be helpful in a nonspecific fashion. If she has no symptoms, it is okay to get a second opinion, of course. Or, you could ask for and arrange a more prolonged consultation with the first endocrinologist to ask such questions directly and set out a proper monitoring and treatment program.