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February 18, 2002

Diagnosis and Symptoms

Question from Barstow, California, USA:

I have type 1 diabetes and have noticed symptoms (weight loss, tired after meals, massive headaches, mood swings, extreme thirst and hunger) in a friend's 15 year old son. On my advice, the mother purchased a "cheap" meter to test him at home, and his blood glucose has been 41-290 mg/dl [2.3-16.1 mmol/L]. His fasting is within normal range, but when he eats as a "normal" teenager does (soda and chips and fast food), his blood glucose shoots to 250-290 mg/dl [13.9-16.1 mmol/L]. Then, within three hours after meals, he's around 130 mg/dl [7.2 mmol/L], and, by four to five hours after meals, he's at 50 mg/dl [mmol/L]. Also, when he's active he drops to 40-50 mg/dl [mmol/L] most times, and exhibits symptoms of hypoglycemia. The boy's doctor feels these are perfectly normal readings and refuses to do an oral GTT or GAD antibody test, but did do an A1c which was 4.6%. I myself have had a few cases of DKA [diabetic ketoacidosis], so, if it' s possible, I would like to save the boy from having to get that far. Is it normal for a teenager to swing so rapidly and broadly? Is there a way to find out other then a GAD, whether or not this young man has diabetes? What is the range to be watching in a teenager?

Answer:

I would have to say that I believe that your friend’s son’s doctor is justified in saying that he does not have diabetes at the present time. He has gone the extra mile in getting an hemoglobin A1c test which was normal. Even though this young man did have some abnormal values on a blood glucose meter, a meter not the best way to assure accurate readings, and they cannot be used for diagnostic purposes. It is quite possible that other explanations can found for them, especially if you discount the stress effect on blood sugars.

I think the doctor is reasonable in saying that routine antibody testing, which is now usually for ICA 512, anti-GAD antibodies, and anti-insulin antibodies as well as a glucose tolerance test are not really indicated. For one thing, there is no accepted treatment for people who are antibody-positive but whose glucose tolerance is still normal. If this young man’s parents have a great deal of anxiety around the issue, I am sure that the doctor could arrange for the tests to be done privately directly through the clinical laboratory.

It is impossible to evaluate the symptoms you describe without seeing this teenage boy, but I don’t think that they particularly suggest any form of reactive hypoglycemia, even though you describe some blood sugar levels that are marginally below normal. My own inclination would first be to see if there is any psychosocial basis for the symptoms and if they are indeed abnormal for the age group. The parents might also request a referral to a diabetes center for further evaluation. It would be nice to have this boy and his family seen to get to the bottom of it all.

DOB