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August 27, 2000

Diagnosis and Symptoms

Question from Kansas City, Missouri, USA:

My daughter is 18 months old. Several months ago, she had a febrile seizure. While in the emergency room they did a glucose test. Her result was 206 mg/dl [11.4 mmol/L]. hile doing a follow-up the next week in the family doctors office, a fingerstick showed her glucose to be 250 mg/dl [13.9 mmol/L]. At that time, my doctor referred us to a local children's hospital. By the time we drove there and got her admitted, her sugar was down to 96 mg/dl [5.3 mmol/L]. However, a Hemoglobin A1c was 7.2& (normal 4.2 to 6.4). The endocrinologist said that to be considered diabetic, it would have to be over 8.0%. We did an insulin test on her and the results were less than 3 (normal 5 to 25). My family doctor then provided us with a machine and she has had sugars two hours after a meal as high as 300 mg/dl [16.7 mmol/L]. It appears to me that on days she runs high she will run high all day long with with fasting sugar levels from 100 to 122 mg/dl [5.6 to 6.8 mmol/L] and after meals from 150 to 300 mg/dl [8.3 to 16.7 mmol/L], but, on days where her sugars are low in the morning, she will stay in the normal range (92 to 139 mg/dl [5.1 to 7.7 mmol/L]) all day long. My father has type 2 diabetes, and I had gestational diabetes, although there are no cases of type 1 diabetes in the family. My daughter has few warning signs that I have noticed, but, when I have tested her sugars and they are high, she does appear to be flushed in the face. Also, at one year of age, she was dry all night, and, now, she wakes up soaking wet. I'm very confused about whether I should be concerned about this or not. My family doctor seems to be concerned about this, but, anytime we contact someone else, they tell us time will tell. Everything I have read about type 1 says that most are diagnosed when they get very sick and end up in the hospital. I am very confused. Do I need to keep checking her sugars? Should I be worried? Is there any way of getting her diagnosed short of her getting very sick?


The blood sugar and serum insulin results are a little difficult to interpret from a distance, but I think it quite possible that your daughter does have type 1A autoimmune diabetes, which is by far the most common form in Caucasian children in North America. A family history of type 2 diabetes and of gestational diabetes is not really relevant. The onset of the clinical stage or of insulin dependence can be erratic and quite gradual. However, gien the the circumstances you describe, I think you should talk to the doctor about getting an antibody test done rather than awaiting events.