September 12, 2010
Diagnosis and Symptoms
Question from Eagan, Minnesota, USA:
I have a 10-year-old daughter that we adopted through the foster care system four years ago. We know very little about her family medical history except that her maternal grandmother died from her diabetes, weighing 500 pounds, and that her eight biological half siblings all have varying degrees of genetic issues. My daughter’s geneticist believes that it will be three more years before we find her issues. My daughter has Fetal Alcohol Syndrome with abnormally shaped kidneys that is followed by a nephrologist. The kidneys work excellently, are just shaped funny. She is developmentally a two- to four-year-old. She was severely abused in all ways so she continues to have food issues. She is still in pull-ups and her urologist thinks that she may never potty train.
This summer, we have observed increased thirst and nonstop eating. She has lost two pounds in 10 days. She has a sore on her toe that we have been treating for over a month and has been difficult to heal. She has two urinary accidents a day plus goes to the toilet often. She is up during the night drinking, eating, and peeing during the night. She is irritable and this is our worst summer behaviorally.
We went to the health fair portion of our state fair and had her non fasting glucose taken at 8 p.m. It was 132 mg/dl [7.3 mmol/L]. The nurse told us to see the doctor soon. I called the pediatrician’s office today and their nurse said to come in right away. The doctor examined my daughter. Her fasting glucose was 86 mg/dl [4.8 mmol/L] and there was no glucose in the urine. The A1c was drawn, but the doctor said it would be several days before the results come back. The doctor told me that she does not have diabetes and it all behavioral.
We didn’t eat that much at the fair because it was so expensive and she hadn’t had anything two hours prior to the test because we didn’t want her to throw up on the bus on the way home. She always has a tummy ache and is tired.
What is your opinion? What should I do? My gut says to follow this further, but I can’t argue with the test results.
Answer:
All these issues are very complicated with some genetics and some abuse on top of one another. It sounds like there was either prenatal brain damage and perhaps some abuse after birth that added to these problems. Any excess urination and thirst, weight loss or change in enuresis pattern should make one consider diabetes. However, the blood glucose levels you describe are probably normal following some food intake and certainly normal fasting. If the A1c is also normal, then your pediatricians is probably correct that this is not diabetes but either kidney and bladder function, psychological trauma, etc. If the same symptoms persist, then repeat glucose testing should also be considered. Stay in close contact with your pediatrician who knows you and your foster child so that further diagnostic decisions can be considered.
SB
[Editor’s comment: See also our page on the Classification and Diagnosis of Diabetes.
BH]
