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March 31, 2005

Diagnosis and Symptoms

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Question from Peoria, Illinois, USA:

I have a strong family history of type 1; my brother and three of my first cousins have the disease. My 10 year old daughter has started to exhibit some strange symptoms. For the past three to four months, she has been complaining about feeling “shaky” and her stomach and head hurting on almost a daily basis, approximately two to three hours after breakfast.

She is slim, active and eats relatively well (something we try hard to watch with the type 1 diabetes in my family). She seems to be a bit more tired and pale than usual and has caught more colds/flu viruses this winter than normal. A few days ago, she had a diabetic friend over and I asked her to check my daughter’s blood sugar. Three hours after breakfast and quite a bit of hard playing outside, my daughter’s blood sugar was 159 mg/dl [8.8 mmol/L]. The next day, I bought a blood glucose meter and starting monitoring her. Most of her readings were well within normal limits, both fasting in the morning and during the day. She did have one reading of 221 mg/dl [12.3 mmolL] three hours after eating three doughnut holes one afternoon (she had washed her hands well, so I don’t think there was a procedural problem).

I did question her about symptoms and other than the “shaky” etc. feelings. Her only other comment was that she was asking for a drink more often, but did not seem to have to use the restroom any more than usual. I took her to our family doctor and her casual blood sugar test in the office was 100 mg/dl [5/6 mmol/L] (four hours after eating) and urinalysis showed no sugar. She has not lost weight since her physical one month ago. The doctor’s suggestion was to watch her carbohydrates and simple sugars more rigorously, and he would like to see her again in four months.

I was surprised that with family history and her hypoglycemic-like symptoms, coupled with the few abnormal blood sugars, he did not schedule additional testing. Should I be concerned and ask for a second opinion?

Answer:

From: DTeam Staff

I understand your concern and no one will be able to predict that your child will or will not develop diabetes. We cannot predict whether ANYONE will develop diabetes. There are certain risk factors (e.g. family history or special genetic profiling). But it sounds to me as if you are not accepting “good news.”

Your daughter may have SYMPTOMS of hypoglycemia (shakiness), but you have not demonstrated actual low glucose values. While you have caught an occasional high glucose, she has not had sustained fasting serum glucose levels greater than 125 mg/dL [6.9 mmol/L].

Please see the many previous questions and links on this web site as to What is Type 1 Diabetes? Your daughter does not have diabetes – today. No testing can predict that she will. Even if she underwent a glucose tolerance test and it was consistent with glucose intolerance, this would not be a free-pass to diabetes.

If you are not reassured and would like to find out if you qualify for a clinical trial for people “at risk”, you might read about Type 1 Diabetes TrialNet, a national research program involving persons at risk of diabetes, and see if a center near you is willing to assess your daughter. Research trials tend to have strict inclusion and exclusion criteria.

Let us know.

DS