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July 30, 2007

Diagnosis and Symptoms

Question from Thorneside, Queensland, Australia:

My mother noticed that my two-year-old was drinking a lot and sleeping more than she should be on a number of occasions. She told me to get her checked since my husband's mother has type 1 diabetes. When I asked my general practitioner, they did a finger prick test that was 10.7 mmol/L [193 mg/dl] so he ordered a fasting pathology test. The morning I was to ring up for the results, I found it very difficult to keep my daughter awake. I took her to the chemist near my house where I purchased I glucose monitor. We tested her then and the reading was 2.4 mmol/L [43 mg/dl]. I had to force a jelly bean into her mouth and she would not allow me to put any others in. We re-tested her 10 minutes later and the reading was 2.2 mmol/L [40 mg/dl]. We then tried a chocolate frog that she was happy to take. We then took into the doctor's next door where he got the pathology results that were 3.8 mmol/L [68 mg/dl]. By this time, she was starting to become normal again. If she does not have diabetes, can her sugar levels go up and down this way? Should I take her to see a specialist?

Answer:

These values are distinctly abnormal. This could be an early presentation of diabetes where the pancreas in its inflamed state is “mis-firing,” sometimes, too much and sometimes, too little insulin. In any case, you should consult with an experienced pediatric diabetologist and should continue to do frequent blood glucose readings for the next few days to determine what are the ups and downs of the blood glucose readings. I would usually recommend a profile as follows: a blood glucose check pre-breakfast plus one to two hours post-breakfast; pre-lunch and one to two hours post-lunch; and pre-dinner and one to two hours post-dinner. This information will help the diabetes folks determine the next step. Other tests to consider would be general chemistry panel, islet cell and GAD-65 antibodies, etc.

SB