I have a family history of diabetes on my maternal side, and since my daughter was diagnosed suddenly with genitourinary reflux, she has had multiple urinary tract infections and one really bad kidney infection. Her blood sugar levels are normally 150-200 mg/dl [8.3-11.1 mmol/L], and during the kidney infection they said they saw sugar and a trace of ketones in her urine but no bacteria. The doctors said stress and sickness could raise her sugar levels. Should I be worried about diabetes? Am I just paranoid?

Blood sugar levels of 150-200 mg/dl [8.3-11.1 mmol/L] are clearly abnormal, and if they persist, could represent diabetes. Your daughter needs to be closely monitored by her physician for the development of diabetes. Her genitourinary reflux is likely not related to her blood sugars.

MSB

[Editor’s comment: With blood sugars at those levels, I would be inclined to advise that you also buy some urine ketone strips and monitor the urine for ketones whenever her blood sugar is over about 200 mg/dl [11.1 mmol/L]. This can help ward off DKA [diabetic ketoacidosis], a life-threatening complication.

In addition, particularly given your family history, ask about having formal testing for diabetes performed at a time when she is free of infection. Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal. See Classification and Diagnosis of Diabetes for further information.

Occasionally, lab blood sugar testing might be normal in an early case of diabetes, repeat blood sugar testing at the same or a different time, or performing a glucose tolerance test, might be appropriate if there is a high suspicion of diabetes despite normal initial testing. Another test, the glycosylated hemoglobin, might be used to help confirm a suspected diagnosis of diabetes, but the GHB (also called HbA1c or A1c) is not usually considered as appropriate to make an initial diagnosis. Antibody testing is occasionally done as a screening test in high-risk situations, or as confirmatory of type type 1A (autoimmune) diabetes, but is not part of routine testing.

Urine tests or home glucose testing, if done, might be positive, which would make the situation more urgent to get lab testing done to confirm the abnormal results. However, urine or home glucose testing, if negative, would not exclude diabetes.

SS]