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January 25, 2004

Diagnosis and Symptoms

Question from Hesperia, California, USA:

My 8-year-old son has type 1 diabetes. Since his diagnosis, and getting all of the supplies, my other children sometimes find it fun and interesting to check their own blood sugars as well. I think that it helps them participate in what their brother is going through. In doing all the "finger sticks" I have noticed that my 6-year-old daughter has elevated (250-350+ [13.9-19.4 mmol/L]) blood sugars quite frequently. I have had urine tests and lab work done on her, all with normal results, and yet we continue to see her levels very high. What do you suggest? I am wondering if maybe she falls into the Type 2 category. She really shows no other symptoms. She is small and thin, her eyes however are terrible. She has been in glasses for two years now and they are still getting worse with episodes of blurry vision, headaches, watery eyes, etc. As I understand diabetes, there are levels that a "normal" person should never be above. If her tests and diagnosis are negative then why do they sugar levels continue to be high? Please give me some advice on a plan of action, any theories to be explored or anything else you can suggest.


Normally blood sugars of 250-350 mg/dl [13.9-19.4 mmol/L] would be considered diagnostic of some form of diabetes. There are two immediate possibilities which I am sure have been resolved, the first being that the calibration of the home instrument was incorrect and the second that the stress of a finger stick had raised the blood sugar to abnormal levels. Without knowing exactly what further tests were done I can only suggest checking that they included a Hemoglobin A1c which would have been a good index of how consistently the blood sugars had been raised over the previous three months.

I would also consider it essential to have a full antibody test by which I mean anti GAD, anti insulin and anti ICA512. The reason for this is that if only one parameter is tested for and it is negative, the other two may still be positive. It is also essential to have such a test done by a laboratory that reports its results not as a single number but as +ve or -ve based on a >3 Standard Deviations from the mean of at least 100 normals. If this test was in fact done correctly and the results were negative this would eliminate the commonest form of Diabetes in young Caucasian children which is the Type 1A or Autoimmune form; but would still leave open the possibility of Type 1B or Idiopathic Diabetes where insulin dependance can be transient and various forms of insulin resistant diabetes including Type 2 and also very rare entities like certain mitochondrial diabetes. It is of course almost certain that this form of diabetes would be the same as in your son; but an entirely different explanation of hyperglycemia as hyperadrenocorticism is possible. You need to discuss all this with the pediatrician or pediatric endocrinologist, if necessary getting a second opinion, and especially the need to start insulin or oral medication.