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June 29, 2000

Diagnosis and Symptoms

Question from Alabama, USA:

My 10 year old daughter (who is 5 foot, 2 inches tall, and weighs 115 pounds) recently had a GTT [glucose tolerance test] and her 30 minute reading was at 190. She had the test done basically because I suspect there is something wrong, and my doctor is kind enough to test to ease my mind if nothing else. In the past month, the child has gotten varicose veins in both thighs; has trouble with physical stamina and also has a lot of fat around her middle. She is not "fat"; it's just around the tummy area. Anyway, as a result of this GTT, our doctor says that she would like for her to see a pediatric endocrinologist because she may have insulin resistance. I have read what I can from your site, but what type of tests would an endocrinologist do to diagnose my daughter? Should I ask the endocrinologist anything specific?

Answer:

From the information you have given, your daughter appears to be only very marginally glucose intolerant. The 90 minute glucose level in the GTT was a little high, but there are many other factors that might have been responsible for that. Also, on the growth chart, she is over the 95th percentile for her age but not significantly overweight for her height. Finally, I assume she has never shown glucose in her urine.

My assessment would be that she does not have diabetes at this time, but I expect that the endocrinologist will be at pains to reassure you on this. He/she may well ask for an antibody test which, if it were positive, would indicate a pre-diabetic Type�1A (autoimmune) diabetic which is by far the commonest form in Caucasian children in North America. Because of the increasing prevalence of Type 2 diabetes in young people a fasting serum insulin or C-peptide test might also be suggested; but with the equivocal evidence of being overweight and no stated evidence of a family history, I think this is unlikely to show any abnormality. There are some other very rare forms of diabetes that might present like this.

I sense that you are anxious about your daughter’s development and because a physical examination was normal you have fixed on diabetes as a possibility. I hope that a thorough and sympathetic evaluation will reassure you.

DOB