September 20, 2006
Diagnosis and Symptoms
Question from Melbourne, Victoriam, Australia:
My 15 year old daughter has recently been having symptoms of diabetes. Type 2 runs in our family; type 1 does not. She has lost weight unintentionally, going from 47 kg to 43 kg (103 pounds to 95 pounds) in about four or five weeks, the last 2 kg (4 pounds) quite rapidly. She is 156 cm (about 5 feet, 1 inch) tall, is more tired than usual, going to the toilet more often, and often feels thirst. Her appetite, as far as I can tell, has not changed.
Two weeks ago, she had an exacerbation of asthma due to a cold, was in hospital for two days on prednisolone and had one shot of hydrocortisone. The following week (last week,) she mentioned the symptoms, all of which started before the prednisolone, to her general practitioner (GP). The GP did a random blood sugar level which was 11.5 mmol/L [207 mg/dl] on Tuesday when she was still of 40 mg of prednisolone. On Friday, two days after she stopped the medication, her blood sugar was 11.4 mmol/L [205 mg/dl]. The next morning, after a 10 hour fast, her levels were to quote the GP “in the upper normal range.”
It has been further recommended that my daughter continue to monitor her blood glucose levels, diet, be supervised while on prednisolone in the future, and have another fasting blood glucose done in six months.
My concern is that my daughter is still not feeling well, in fact, seems worse, and is still experiencing diabetic like symptoms. Her morning blood sugar levels are fine, typically between 4 and 7 mmol/L [72 and 126 mg/dl], but, during the day, her blood sugar levels are often between 10 and 12 mmol/L [180 and 216 mg/dl].
I’m at a loss of what to do for her. Should she be seen by her GP again or wait it out for six months?
Answer:
Please see other related questions about Diagnosis and Symptoms on this site.
I believe that your GP is being a bit too conservative here. By DEFINITION, diabetes can be diagnosed when any of the following are documented:
A fasting serum/plasma (not “fingerstick”) glucose that is confirmed greater or equal to 126 mg/dL [7.0 mmol/L]; OR
a RANDOM serum/plasma (not “fingerstick”) glucose that is confirmed greater or equal to 200 mg/dL (11.1 mmol/L) PLUS symptoms (increased thirst, increased urination, weight loss, etc.); OR
if the two hour serum/plasma glucose in a properly performed oral glucose tolerance test is greater or equal to 200 mg/dL (11.1 mmol/L).
Based on your description of your daughter, this story sounds highly suspicious of diabetes to me. If confirmed, the determination of type 1 versus type 2 diabetes will come later. But, I would NOT delay: I would recommend more immediate follow-up. Your GP may have additional information. Please talk with him/her again soon.
DS
