February 8, 2007
Diagnosis and Symptoms
Question from Shreveport, Louisiana, USA:
I am an adult endocrinologist. My cousin, who has type 1 diabetes and on a pump, recently took in a foster child who is 23 months of age and very overweight. The child has been drinking copious water for three weeks. The foster mom checked the child’s blood glucose and it was about 180 mg/dl [10.0 mmol/L]. Subsequently, she has had several fingersticks of about 180 [10.0 mmol/L] after eating. Fasting sugars have been normal. Urine ketones were negative. She took the child to the pediatrician who laughed at her. The child is not acutely ill. I have not been able to get a pediatric endocrinologist to call me back. Would anti-GAD, IAA, etc., be indicated? Would an AIc help? What about glucose tolerance testing or just a laboratory postprandial sugar? I told her to take the child to the hospital if she gets large ketones. Should we worry about type 2?
Answer:
I certainly agree and wouldn’t laugh. Is she a minority and at risk for diabetes? I think the idea of a fasting and non-fasting laboratory glucose readings is good. An A1c and the mentioned antibodies seem okay. If it’s likely you’re actually looking at risk for type 2, you might even check the C-Peptide.
I apologize for my colleague’s lack of class. Always talk to a fellow physician.
LD
