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July 28, 2007

Diagnosis and Symptoms

Question from Michigan, USA:

On July 4, my five and a half-year-old daughter complained of not feeling well and being tired. She had just awakened so this was quite unusual. Since I have type 1 diabetes and my wife is a general pediatrician, whenever any kind of behavior/symptom is shown that could indicate diabetes, I always do a fingerstick. The first fingerstick at approximately 10:30 a.m., about an hour after breakfast, was 234 mg/dl [13.0 mmol/L]. The period of elevated blood sugars lasted approximately three hours. At 10:56: a.m., she was 261 mg/dl [14.5 mmol/L]; at 12:08 p.m., she was 260 mg/dl [14.5 mmol/L]; and at 2 p.m., she was 185 mg/dl [10.3 mmol/L]. Around noon, my daughter finally went to the bathroom. She had moderate amounts of both glucose and ketones in her urine. We did another urine test at 2 p.m. and it was negative for glucose and ketones. No insulin was ever administered. Since then, we have done frequent testing approximately eight times per day, upon awakening and pre- and post-meals and snack. Every test has been in the normal range. All morning fastings have been under 90 mg/dl [5.0 mmol/L]. We had antibody tests done and we are waiting for results. We had an A1c done and a fasting glucose at a laboratory. Her A1c was 4.7 and her fasting glucose was 66 mg/dl [3.7 mmol/L]. I conducted my own home version of an OGTT, 16 ounces of apple juice, 60 grams of carbohydrates. Two hours afterwards, my daughter's blood sugar was 102 mg/dl [5.7 mmol/L]. This was done at 4 p.m. on the day of the suspicious morning glucose readings. My daughter has asthma and uses Pulmicort. She spent the previous week at camp in 90 degree Fahrenheit heat and was quite fatigued after missing her nap for the entire week. No other symptoms were observed and I feel quite sure that my wife and I wouldn't miss any. What do you think about this?


You are not the first parent whose child has experienced elevated blood sugars. I have had similar episodes in a number of children. High blood sugars come and go and diabetes doesn’t result. Do back off the number of tests. If the antibodies are positive, I would test every now and then so as to not miss the development of diabetes if it is going to occur. I believe she is too young for most of the experimental interventions.