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October 11, 2018

Diagnosis and Symptoms

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Question from British Columbia, Canada:

As part of a blood panel, my daughter had a random high blood sugar of 17 mmol/L [306 mg/dl]. We were called in and determined she had a bladder infection, which must have been the cause as she passed a one hour glucose test and was GAD negative. Her a1c was 5.6 and they sent us home with a glucose meter and said to come back in three months. We tested and found results as high as 17 mmol/L [306 mg/dl], but her blood sugar would go back down to 7 to 8 mmol/L [125 to 145 mg/d] after a few hours. She has never had any concerning symptoms. She is thin and very active.

Recently, she has had bouts of low blood sugar, usually after she has gone to bed. She will come and wake me, say she is feeling sick and will be between 2.3 to 3.5 mmol/L [40 to 63 mg/dl]. A piece of toast will cause her to jump to 14 to 15 mmol/L [252 to 270 mmol/L], fifteen minutes later, but will always return to normal. I have seen no high numbers during the day and her recent a1c was 4.5. The only abnormal thing right now is when she wakes up and does a fasting blood sugar, which is usually around 6.5 mmol/L [117 mg/dl], her blood sugar drops after she eats. It’s been a year since the initial high result. Do you have any idea what might be going on with our daughter?

Answer:

Unfortunately, it sounds like she has the earliest stages of diabetes. Sometimes this is called prediabetes and sometimes metabolic syndrome, especially if she is also overweight or has something called acanthosis nigricans. I would usually want you to be testing her blood sugar levels before and afer meals more frequently than what you report. I also would be interested to see what her insulin levels are, C-Peptide levels are and what her A1c levels are doing sequentially to see if things are staying the same or changing. Low carbohydrate meals and snacks would also likely help her “damaged” pancreas since it would not need as much insulin as currently.

You also only mentioned GAD antibody testing but there are also several other antibodies to be checked, four in total. So, you should contact your medical team and let them know what blood sugar results you are getting, that they are still intermittently elevated. Ask them if some of the other antibody tests were actually done or if any of the antibody tests need to be repeated.

SB