February 27, 2001
Diagnosis and Symptoms
Question from Novi, Michigan, USA:
Four weeks ago, during a routine physical examination, my nine year old daughter had a trace of sugar in her urine. A subsequent blood test revealed a blood glucose level of 170 mg/dl [9.4mmol]. She had eaten an apple and a high fructose juice box 45 minutes prior to the test. The following day, she was admitted to the hospital for further tests and observation. Her HbA1c was 5.4% and she had a negative ICA test. We have monitored her blood glucose levels since this time. Her fasting values have averaged 92 mg/dl [5.1 mmol/L], and her pre-dinner numbers have averaged 93 mg/dl [5.2 mmol/L]. She has none of the “warning signs” of diabetes.
She had a mild cold at the time of her initial doctor’s visit. Also, for the past four months she also has been on a prescription medication for anxiety issues with going to sleep at night, and she has grown one-half inch since this experience has started.
She is scheduled to have an intravenous glucose tolerance test in a week, and I have several questions:
Does she have diabetes?
Could the cold, the medication, or the growth spurt have some effect?
What is the Intravenous glucose tolerance test? What should I be looking for?
Will the intravenous test tell us if she has diabetes?
The doctor said he may suggest low levels of insulin twice a day as “prevention” per some recent research. Is this advisable? I am very concerned about hypoglycemia.
Answer:
Neither a single dipstick discovery of some glucosuria nor a single random, non-fasting blood sugar level of 170 mg/dl [9.4mmol] is diagnostic of diabetes in an otherwise asymptomatic nine year old. With the subsequent quite normal blood sugars, a normal hemoglobin A1c and negative islet cell antibodies, I think it very unlikely indeed that your daughter has diabetes.
The intravenous glucose tolerance test is one in which blood insulin or C-peptide levels are measured at one and three minutes after an IV load of glucose. The sum of these two levels is used as an index of insulin reserve. It is a test that might reveal an underlying degree of insulin insufficiency that could have been due to pre-diabetes rather than to a mild anxiety state and the stress of an early cold.
My personal feeling is that if the doctor felt that further tests were needed it would be better to get a more extensive antibody test that include ICA512, which is an immunoassay and not the less accurate screening ICA, an anti-GAD and an anti-insulin (IAA) level.
In these circumstances, I do not think that insulin is indicated unless one of the more definitive antibody tests were positive. There is no evidence that the anti-anxiety medication has contributed to these findings. if anything, it would ameliorated any stress effects on the single abnormal blood sugar test.
DOB