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May 21, 2020

Diagnosis and Symptoms

Question from Dillon, South Carolina USA:

My child has been running a glucose reading of 126 to 161 mg/dl [7 to 8.9 mmol/L]. The doctors are saying she isn’t a diabetic because her A1c is running normal at 5.3. But, they are sending her to a urologist and an endocrinologist. Her eyes are constantly hurting her, she is urinating a lot, and is tired every day. There is diabetes in both sides of the family. Is she showing signs of diabetes early stage or should I be concerned?


From: Dr. Stuart Brink

These are borderline high blood sugar levels. The A1c indicates that these levels are not staying very high for long enough time to raise the A1c itself. I don’t think she needs a urologist but going to a good pediatric diabetologist who has access to antibody testing may provide important information. For instance, there are currently four separate antibodies that we know seem to predate overt high sugars/clinical diabetes. For instance, if she were to have positive antibodies, she might be eligible to participate in a clinical study to slow down the damage to the pancreas’ insulin producing beta cells. If negative, that lowers her future risk. The antibody tests are not 100% specific but give us some clues.

At the same time, it would be important for this child not to gain excess weight since that is another risk factor that is approachable. Similarly, working with a dietitian and diabetologist to lower excess simple carbohydrate intake (juice, fruit, breads, rice, etc.) would also help potentially avoid the lack of insulin from producing clinical diabetes. And, finally, the family needs to be aware of the symptoms of DKA (Diabetic Ketoacidosis) – increased urination, nocturia, enuresis, unexplained weight loss, fruity odor of the breath (ketones) – to avoid a severe episode of DKA that could lead to hospitalization.