My nine-year-old daughter was 6 pounds, 8 ounces at birth, but has been large since. She is 128.5 pounds, blood pressure 130/80. Although she is overweight, she is very active and consistently hungry. On several occasions, we checked her blood sugar both random and fasting. She has had two instances where she was 350 mg/dl [19.4 mmol/L], but by the time we decided to go to the hospital, she was down to 80 mg/dl [4.4 mmol/L]. Her A1c was 5.1. My meter was compared to the one in the Emergency Room (ER). I’m an LPN and do these test regularly.

Two years ago, she was 300 mg/dl [16.7 mmol/L] at home, 400 mg/dl [22.2 mmol/L] in doctor’s office. The doctor sent us to the ER for possible admission, but my daughter’s blood sugar had gone down to normal by the time we got there. The other day, she was 350 mg/dl [19.4 mmol/L]. About 90 minutes later, she was 88 mg/dl [4.9 mmol/L] at the hospital. Again, I compared my meter with the hospital reading and got the same results. So, should I continue to check or not? Does the A1c of 5.1 rule out diabetes?

For her age, nine, your daughter is over the 97th percentile for weight for her age; furthermore, her blood pressure is high. You don’t give her height in order to calculate her body mass index (BMI) or to give upper limits of blood pressure for age and height.

She has had some glucose levels that are CLEARLY ABNORMAL. Please refer to some of the many, many questions on this web site about the Diagnosis and Symptoms of Diabetes. Keep in mind that an A1c is NOT a diagnostic criteria. So, a normal A1c does not exclude the diagnosis of diabetes. I don’t know that she has diabetes, but I am very suspicious, mostly of type 2 diabetes. I do not recommend oral glucose tolerance tests (OGTT) often, but this might be a situation for a PROPERLY performed OGTT.

A proper test requires:

Assuring the child eats at least 60% of the calories as carbohydrates for the three days leading up to the test;

A MAXIMUM glucose load of 75 grams for a child her weight (some laboratories will “forget” and do the glucose load for pregnant women and give 100 grams of glucose);

Have the glucose and INSULIN levels checked from a vein and run in the laboratory (NOT a home or bedside glucose meter).

If you have not had the child seen by a pediatric endocrinologist, that may be helpful, but your pediatrician should be able to assess and manage your daughter at this point.

DS