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June 6, 2003

Diagnosis and Symptoms

Question from Glenwood, Arkansas, USA:

My eight year old daughter is skinny and tall and cannot seem to gain weight, even though she eats quite often. She has every major symptoms of type 1 diabetes (frequent urination, constant thirst, difficulty waking up in the morning). Occasionally when we are somewhere and can't get to food right away, we've noticed a fruity odor to her breath, and after eating some foods, she becomes uncontrollable and has trouble learning as well. She has had some fingerstick blood sugars of 30-245+ mg/dl [1.7-13.6 mmol/L]. About eight months ago, she had a six-hour GTT done in the pediatric endocrinology clinic of the children's hospital. She had a fasting plasma glucose of 138 mg/dl [7.7 mmol/L], and her one through our-hour values were 189-195 mg/dl [10.5-10.8 mmol/L], but then she bottomed out at 40 mg/dl [2.2 mmol/L] into the fifth hour. With each blood sugar result, she was spilling sugar in her urine, but her hemoglobin A1c was 4.7% The pediatric endocrinologist said her blood work results indicated hypoglycemia, and I would seek a second opinion, but the only pediatric endocrinologists in our state are all in the same clinic. What is your opinion?

Answer:

This is very interesting. I would like to know details of the glucose tolerance test. As can be read on this website, there is a very proper way to do a glucose tolerance test, which unfortunately, sometimes gets short-cutted. For the three days before the test, at least 60% of the calories should be from carbohydrates. A specific glucose load is dictated: 1.75 gm per kilogram body weight to a maximum of 75 grams; (often a larger dose is inappropriately given). Ideally, glucose and insulin levels are measured in the samples. I am assuming that the glucose levels you provided were analyzed in a laboratory and were not simply done with a glucose meter.

With all that, I would interpret the results as not fulfilling criteria for diabetes, but the results do fulfill criteria for impaired glucose tolerance (now being described as “pre-diabetes” — a term which I think is not good.) The last value is suggestive of reactive hypoglycemia. The other results you report are not worrisome. P> Although the endocrine consultants may be all in the same clinic, they may not have the same practice applications. The pediatric endocrinologists in your area are very talented people, so please discuss your concerns.

DS