August 22, 2005
Blood Tests and Insulin Injections, Diagnosis and Symptoms
Question from Fairbanks, Alaska, USA:
My daughter is five years and three months old. We are Caucasian and live in Fairbanks, Alaska, which is where natives have a high incidence of diabetes so, I thought it would be a reasonable question to ask your team. She is 43.5 inches tall and weighs 60 pounds. She was not overweight a year ago and when she first showed signs of a belly, we thought we anticipated a growth spurt. It did happen, but it just did not ever even out.
She seems more frequently thirsty to me than her playmates/sibling and wets her bed about three times a week. She has what looks like a diaper rash about two or three times a month. Also, she is an irritable child. She has light brown patches on her neck and in her armpits, according to the pediatrician. She is easily fatigued and more sedentary than her sister/playmates.
We have begun the screening process for diabetes, assuming it is type 2, and can be addressed through exercise. So far, the test results show no sugar or ketones in her urine. Her LDL cholesterol is 96 and there are no indicators that she has thyroid problems. We are still waiting on her antibodies test results and the insulin test results, which I guess relates to the insulin level in her blood versus what is anticipated.
Usually, my daughter gets 11 to 14 hours of sleep and dinners that we think are a healthy carbohydrate to protein ratio. A typical dinner consists of four ounces of tuna, one slice of bread, one cup of tomato/red pepper soup, then mild exercise, i.e., a short bike ride, and a cheese stick as a bedtime snack. Her fasting blood sugars have been 97 mg/dl [5.4 mmol/L];89 mg/dl [4.9 mmol/L]; and 102 mg/dl [5.7 mmol/L]/ Her A1c was 6.0.
I know that these fall in the range of normal for an adult, but they seem a very high-end of normal considering the food choices and activity level and the time span. I cannot find any information about what a normal range for a non diabetic five year old girl should be, only type 1 targets ranges. Are these high? Are there ranges for a non-diabetic child or should her fasting blood sugar levels be the same as an adults?
Answer:
Blood glucose levels for a five year old are the same as for adults. Before eating and middle of the night, blood glucose should be below 100 mg/dl [5.6 mmol/L]. After eating, one to two hours after food, maximum, with home monitoring, around 140 mg/dl [7.8 mmol/L] (some would say 126 mg/dl [7.0 mmol/L]). The A1c range should be about 4 to 6 so 6.0% is high normal, same as for adults. This suggests some periods of high sugars and consistent with the blood sugar levels you reported that are borderline. If the dark skin areas are acanthosis nigricans, this suggest insulin resistance and is likely related to her obesity. If you cut sufficient calories and increase activity sufficiently each day, this decreases fat cells, decreases weight and thus less insulin is required and helps with the associated insulin resistance and high sugars. Assuming that the weight is the key driving factor in your child, whether or not Alaskan native or not, then this is the key treatment option. She is young, but metformin and other oral agents could also be considered, as could insulin. There is some evidence from England that obesity is involved with the earlier onset of type 1 diabetes in children even if not classically type 1a autoimmune diabetes. Either way, key decisions should be made based upon frequent blood glucose monitoring before and after food to look for patterns. You should be working closely with a pediatric diabetes expert and nurse, and a dietician with this complicated situation. There are some new genetic tests for MODY recently available as well as the standard autoimmune antibodies (islet cell, GAD65, insulin, IA, etc.).
SB
