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August 11, 2005

Diagnosis and Symptoms

Question from Hemlock, Michigan, USA:

Three months ago, I learned I have diabetes. I have it in control, but now see the signs of it in my grandson and I am fearful. He is seven and overweight. He drinks a lot and goes to the bathroom often. He seems to have highs and lows. I tested him with my meter and he was 109 mg/dl [6.1 mmol/L]. His mother and father are not together and she will not listen to any concerns and feeds him all the wrong foods, including lots of junk and fast foods. What should a normal reading be? His doctor will not have tests run unless his mother okays it even though the child's father has joint custody. To make a long story short, what should we do? He weighs around 95 pounds at 4 feet tall.

Answer:

I don’t want this to seem to picayune, but the comments regarding his weight might depend on his true birth date and actual height.

For a boy anywhere from seven years even to seven years, 11 months, a height of “four feet” (which I will assume you mean 48 inches and NOT, for example, “49 1/2” inches) would plot your grandson somewhere between the 50 to 55% for height while a weight of 95 pounds would suggest that he is significantly overweight, well above the 97th percentile. You may be familiar with the concept of Body Mass Index, a mathematical depiction of weight versus height. His BMI calculates then to 29, which is obese for a school-aged child. On the other hand, if it is has been, for example, “eight months since his seventh birthday,” his height and weight will plot slightly differently on the growth chart.

While it is reassuring that his glucose was normal with your glucose meter, the symptoms you suggest and his weight certainly are suggestive of diabetes mellitus. At the very least, he is at risk of some degree of glucose intolerance because he may be about 40 pounds or more overweight, based on the numbers you gave.

It is difficult to be the grandparent and then question the parenting decisions of your own child towards the grandchild. Hopefully, the child’s doctor is on the same page as you. You indicated that the child is seen by a general practitioner. Too commonly, physicians who do not work primarily with children do not chart the child’s measurements properly on a growth chart (e.g. charting a child at age seven years, eight months at the “seven year old” spot on the chart). Maybe the doctor hasn’t appreciated just how overweight the child is, again assuming your numbers are true. A team approach, where no one is made to feel “guilty or inadequate” (this goes for the parent as well as the child) would be my preference here. Perhaps you can attend the next visit with the family doctor or an appointment with a pediatrician and share your concerns there in a non-judgmental way.

DS

[Editor’s comment: For information on normal blood sugar ranges, see Classification and Diagnosis of Diabetes.

BH]