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September 21, 2006

Diagnosis and Symptoms

Question from Melbourne, Australia:

My child is undergoing evaluation for diabetes because of weight loss, tiredness, increased thirst, and an increase in voiding. Her blood sugars are all over the place. She was tested twice at the general practitioner's office and had values of 207 mg/dl [11.5 mmol/L] and 218 mg/dl [12.1 mmol/L]. She had a fasting blood sugar done which was normal, but her random blood sugars are often still high. Friday, she was quite high. Her fasting blood sugar was 101 mg/dl [5.6 mmol/L]. After breakfast, she was 176 mg/dl [9.8 mmol/L]; after a lunch of a honey sandwich and coffee, she was 281 mg/dl [15.6 mmol/L]; and before dinner, about six hours later, she was 236 mg/dl [13.1 mmol/L]. Yesterday (Saturday), my daughter was 176 mg/dl [9.8 mmol/L] fasting, but she went down throughout the day. She was 101 mg/dl [5.6 mmol/L] before dinner and 110 mg/dl [6.1 mmol/L] after dinner. Today, she was 58 mg/dl [3.2 mmol/L] fasting and 182 mg/dl [10.1 mmol/L] after lunch. She will be following up with her general practitioner again after another fasting blood sugar test as she is still not well. I'm a bit confused given these recent drops in blood sugars with normal fasting blood sugars. Is it possible she really does have diabetes?

Answer:

Please see other related questions about Diagnosis and Symptoms on this site.

I believe that your general practitioner is being a bit too conservative here. By DEFINITION, diabetes can be diagnosed when any of the following are documented:

A fasting serum/plasma (not “fingerstick”) glucose that is confirmed greater or equal to 126 mg/dL [7.0 mmol/L]; OR

a RANDOM serum/plasma (not “fingerstick”) glucose that is confirmed greater or equal to 200 mg/dL (11.1 mmol/L) PLUS symptoms (increased thirst, increased urination, weight loss, etc.); OR

if the two hour serum/plasma glucose in a properly performed oral glucose tolerance test is greater or equal to 200 mg/dL (11.1 mmol/L).

Based on your description of your daughter, this story sounds highly suspicious of diabetes to me. If confirmed, the determination of type 1 versus type 2 diabetes will come later. I would NOT delay: I would recommend more immediate follow-up. Please make sure you talk with your general practitioner soon.

DS