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February 15, 2005

Diagnosis and Symptoms

Question from Sevierville, Tennessee, USA:

My two year old daughter has been showing some of the symptoms of type 1 diabetes. She has been drinking a lot, including an eight ounce cup within minutes and then want more. She has been wetting more excessively and her urine has a strange, strong odor to it. She has lost about four pounds, yet her eating hasn't changed. If anything, she eats better. My cousin, who has a child with type 1 diabetes, checked her level and it was 236 mg/dl [13.1 mmol/L]. She rechecked and it was 233 mg/dl [12.9 mmol/L]. I took her to the doctor the next morning. They did a glucose only test and it was 78 mg/dl [4.3 mmol/L]. They told me to feed her and recheck. Her blood sugar was then 98 mg/dl [5.4 mmol/L]. I was sent home and told not to worry. I asked them to send me home with a Freestyle kit. I did a test and it was 142 mg/dl [7.9 mmol/L]. The next morning, I did an eight hour fasting test and it was 78 mg/dl [4.3 mmol/L]. I am concerned, but the doctor does not seem to be. Could she be in the beginning stages of type 1 diabetes? Could this be the honeymoon period? Is there anything else that would cause her levels to go up and down like that?


I would probably be a little more aggressive given this history and the discordant values and consider doing pancreatic antibody testing (ICA512, GAD 65, insulin autoantibodies) and/or even consider doing a properly performed oral glucose tolerance test. The test differs for pregnant women than for most everybody else. Specifically:

In the days leading up to the test, at least 60% of the calories consumed should be carbohydrates.

The glucose load is very specific: 1.75 grams per kilogram that the child weighs, to a MAXIMUM of 75 grams.

VENAPUNCTURE glucose and insulin, done by a laboratory, not on a glucometer, should be done at the beginning, 30 minutes, 60 minutes and two hours.

If the doctor’s office also used a glucometer to screen your child, do you/they know the last time it was calibrated, controlled, checked, etc.? Glucometer readings can screen for glucose but they should not be used to make a diagnosis.