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August 13, 2007

Diagnosis and Symptoms

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Question from Texas, USA:

I recently took my daughter in because of elevated blood sugars. It is nothing for her to have a fasting blood sugar in the 150s mg/dl [8.3 to 8.8 mmol/L], then sometimes her blood sugars will rise into the 200s mg/dl [over 11.1 mmol/L]. I have been keeping a log of all of her blood sugars since July 12. Her pediatrician suggested some laboratory tests, which included an A1c. This test came back normal, 5.1. He then suggested that we go have a 3 hour glucose tolerance test done. I then took her to the laboratory suggested, and while they gave her the drink, they rechecked her blood sugar. Thirty minutes later, I checked her blood sugar on her glucometer and it would not even register because it was so high; it flashed greater than 600 mg/dl [33.3 mmol/L]. They drew some more blood one hour later and I again rechecked her blood sugar on her glucometer and it read 381 mg/dl [21.2 mmol/L]. After two hours, her blood sugar was 200 mg/dl [11.1 mmol/L] on her glucometer.

After the testing was completed, she was starving so she had half of a strawberry Pop Tart that I had brought in the car. We went to go find someplace to eat. Before we ate, I made her recheck her blood sugar to determine what she should have. Her blood sugar was up to 287 mg/dl [15.9 mmol/L], probably from the Pop Tart.

When we got her laboratory tests back, it showed that the highest her blood sugars reached was 118 mg/dl [6.6 mmol/L]. I am really concerned because since all of this, I have been continuing to check her blood sugars and they are still sometimes in the 200s mg/dl [over 11.1 mmol/L]. The doctor said that he could not get her in to see a pediatric endocrinologist since the tests showed she was negative for diabetes.

I really thought that I was crazy at this time. But, I checked the machine, called the company, checked the strips, etc. I have even checked her blood sugar on three different machines when her blood sugars go up into the 200s mg/dl [over 11.1 mmol/L] and they all read the around the same, maybe a couple of numbers different. Sometimes her blood sugars are somewhat normal, but never below 100 mg/dl [5.6 mmol/L] fasting. She has good days and bad days. She is not overweight and during her glucose tolerance test she never got sick or felt like passing out. However, she did get very sleepy and fell asleep before we got home, and, when we got home, she slept all afternoon. She didn’t even want to get up later that evening. I also notice that whenever her blood sugars are somewhat normal, she constantly complains about having a headache. Her head constantly hurts and so does her stomach. What really makes her blood sugar rise is after she has been running or gets really hot. What possibly could be going on with her if she is not diabetic? What should my next step be?

Also, when I started analyzing her report, I noticed that the laboratory workers didn’t get the blood until 9:00 p.m., even though it had been collected at 8:30 a.m. They then reported the results to the doctor at 2:30 a.m. the next morning. They also never put her name on the blood tubes. There were two pregnant women in the laboratory having the same test done. Do you think they might have switched the tubes on accident? Surely there would not be a big difference between the readings on her glucometer and the laboratory’s blood draw. Please ease my gut feelings and tell me what to do next?

Answer:

From: DTeam Staff

These values are definitely abnormal and I would suggest consultation with a pediatric endocrinologist with expertise in diabetes. She may have what is called pre-diabetes or could have a different type of diabetes, something called MODY. There are special antibody tests that can be done and also special genetic tests available to help sort this out. Bring your own records and bring the glucose tolerance test results as well.

SB