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August 3, 2005

Diagnosis and Symptoms

Question from Aiken, South Carolina, USA:

My 14 year old daughter, who does not have diabetes had a blood sugar of 168 mg/dl [9.3 mmol/L] about an hour after eating. We were attending the Friends for Life Conference, since my 12 year old has had type 1 for four years, and she was tested in the exhibit hall. She predicted it would be high based on how she felt. One hour later, it was 97 mg/dl [5.4 mmol/L]. Previously, the highest blood sugar for her was 142 mg/dl []7.9 mmol/L]. Since this time, my daughter has had two episodes of being shaky before a meal. We did not have a monitor available or I would have checked her. She has a doctor's appointment next week for a sports physical and I want to know if I should push for further testing. Is there really any test that could determine if my daughter is developing diabetes at this point if indeed she is? I know there are clinical trials being conducted on those diagnosed early and that is why I want to know what to do. Can children participate in those trials?

Answer:

Different clinical trials have specific inclusion and exclusion criteria for subject participation. Given that you have a 12 year old with type 1 diabetes, your 14 year old (as well other first and second degree relatives) would likely qualify to participate in TrialNet, a project to identify patients AT RISK for the development of diabetes, which hopes to culminate in a preventive intervention for those at risk but without diabetes. Given your location, I am certain that your state’s University Medical School to your East in the state capitol is gearing up as a TrialNet site. The medical school just across the state line to your west may also be involved, but I am not sure. You can contact me at your convenience to discuss this formally.

In the meantime, I’d suggest that you ask your daughter’s primary doctor to perform a fasting serum glucose (from a venipuncture stick–NOT simply a glucometer) and possibly also a second serum glucose (also from a venipuncture) two hours after she eats a high carbohydrate breakfast. The values you give are suspicious, but not diagnostic, for some glucose intolerance. Other special testing, of which your primary doctor may not be aware or comfortable interpreting, would be special pancreatic antibody testing for type 1 diabetes. TrialNet will do these special tests for free, if she qualifies and participates.

DS