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October 24, 2001

Diagnosis and Symptoms

Question from Hamilton, New Zealand:

For about 10 months, my three year old son has had elevated blood glucose levels which have caused him to be hospitalised a couple of times. Initially, the doctors informed me he had diabetes, but his high levels were not constant, and his blood tests were normal so they decided it wasn't diabetes. Two months ago, he was diagnosed with epilepsy and most of his seizures have stopped with treatment, but his sugar levels are still up and down. I test him a couple of times a day, and his levels range anywhere from 4.0 to 25.5 mmol/L [72 to 459 mg/dl], and a month ago, he again was in hospital where his levels were normal (4-7mmol/L [72-126 mg/dl]), and all tests were supposedly normal once again. I am becoming increasingly frustrated with this as when his sugars are high he is a very different child. He attends daycare full time, has regular meals including morning and afternoon tea, and he is on a sugar free diet. His hands are washed before testing so there is no residue on his fingers for the meter to pick up on. Can you offer any explanation for this? His specialist is also very frustrated, but I feel like an idiot when he is hospitalised and everything is normal (which is one of the reason for the meter -- at least she can see the memory results!). I would appreciate any advice you can offer.

Answer:

A normal glucose value is about 3.9-6.1 mmol/L [70-110 mg/dl]. A fasting glucose value greater than 125 mg/dl [6.9 mmol/L] defines diabetes.

Why were you checking the glucose values in the first place? I think you have appropriately looked for some factors that could give falsely high values (like sticky fingers). Make certain you are using the correct control chip in the meter. You can also measure a control solution to help you verify that you are getting accurate readings/values.

Most children with diabetes have pretty straight forward symptoms with increase in urination and increase in thirst being the most prominent. Not all blood glucose elevations equates with diabetes. Could he be in a smoldering form? You might ask your consultant to consider a couple of different tests, if you confirm that the home glucose readings you are getting are indeed high:

If he has a high sugar at home, rush him to nearest hospital lab and get confirmatory blood test there.
Ask for a measurement of the hemoglobin A1c. This test assesses overall blood glucose values for the prior 8-10 weeks. It is not a good test to screen for diabetes, and so may not be helpful. A similar test called, “fructosamine” measures overall glucose values for prior two weeks. It is less reliable in my view and has a wide range of normal, but if the value is quite high, it might help your child’s doctors.

To best screen for risk of type�1 diabetes, then perhaps measuring the various pancreatic antibodies might be helpful. The common ones include GAD, iCA512, and insulin autoantibodies.

I don’t consider glucose tolerance tests very often, but this might be such a situation. if your son’s physicians were to consider this, perhaps they would perform an intravenous glucose tolerance (IVGTT) test rather than an oral glucose tolerance test (or maybe even both). With the IVGTT, they can measure the insulin pulse release. Glucose tolerance tests require specific conditions to perform most correctly.

DS