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January 16, 2007

Diagnosis and Symptoms

Question from Huntsville, Alabama, USA:

I have written you several times before about my 11-year-old daughter. Last month, her endocrinologist did another glucose tolerance test. This time, he checked her glucose and insulin levels simultaneously. The results: fasting glucose: 89 mg/dl [4.9 mmol/L]–insulin 11.9; one hour reading: 126 mg/dl [7.0 mmol/L]–insulin 56.4; two hour reading: 100 mg/dl [5.6 mmol/L]–insulin 48.1; and three hour reading: 97 mg/dl [5.4 mmol/L]–insulin 29.

Although her blood sugars very normal, we are still getting a lot of highs at home. He now seems to think it may be type 2. Also, her triglyceride level was 202 and her total cholesterol was 113. My daughter is very thin and active. Do you think that it is possible that this is type 2? He did say he could not totally rule out the early stages of type 1, but, for now, we need to treat it as type 2.

What really has me confused is that when, on rare occasions, she does eat sugar, she goes really low. Last week, she had a cookie after dinner and her two hour after dinner reading was 51 mg/dl [2.8 mmol/L]. Then, the next day, I checked her after dinner and she was 369 mg/dl [202.5 mmol/L]. I rechecked her thinking I had not cleaned her finger enough and she was 371 mg/dl [20.6 mmol/L]. An hour later, she was 305 mg/dl [16.9 mmol/L]. Then another hour later, she was 160 mg/dl [8.9 mmol/L]. I am so confused about what is going on with my daughter. Her fasting levels still are anywhere from 100 mg/dl [5.6 mmol/L] to 124 mg/dl [6.9 mmol/L]. I’m just having a hard time accepting that this is type 2 when my daughter does not meet any of the criteria for it. Are her insulin levels really high enough that it could point to type 2?


From: DTeam Staff

The glucose tolerance test results that you report are not problematic, but the random high and low blood glucose readings certainly are abnormal and suggest to me a “thermostat” problem with the pancreas either over or underproducing insulin periodically. Some of the newer genetic tests for diabetes may be interesting to consider. Have these been done? If they were positive, they may point to a specific medication/treatment. If negative, they won’t help, unfortunately; similarly for islet and GAD-65 antibodies. None of these are 100%, but they may provide more information. I would encourage you to go back and discuss this further with your endocrinologist so that you can work out the best food/dietary system for the moment, what monitoring is needed at home and at the office/clinic, etc.