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February 13, 2003

Diagnosis and Symptoms

Question from Orlando, Florida, USA:

My seven year old daughter (who is very thin) has just recently started to want to have water with her more than usual (wants to bring it in the car, takes some to bed with her at night). I haven't really noticed a major increase in her appetite, as she has always been a picky eater, but have noticed her stating she is still hungry at times after just eating. Do the symptoms of diabetes all occur at one time, or can one or two occur first, then other symptoms follow?

Answer:

I really understand your concern regarding the possibility that your daughter’s symptoms might be related to diabetes mellitus. Besides symptomatology interpretation, I’d check her as soon as you can, with a serum determination of a fasting and random glucose concentration and a urinalysis. You need to ask a pediatrician for a referral to a pediatric endocrinologist if diagnosed.

MS

[Editor’s comment: Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal. See Classification and Diagnosis of Diabetes Guidelines. for further information.

Occasionally, lab blood sugar testing might be normal in an early case of diabetes, repeat blood sugar testing at the same or a different time, or performing a glucose tolerance test might be appropriate if there is a high suspicion of diabetes despite normal initial testing. Another test, the glycosylated hemoglobin, might be used to help confirm a suspected diagnosis of diabetes, but the GHB (also called HbA1c or A1c) is not usually considered as appropriate to make an initial diagnosis. Antibody testing is occasionally done as a screening test in high-risk situations, or as confirmatory of type type 1A (autoimmune) diabetes, but is not part of routine testing.

Urine sugar tests or home glucose testing, if done, might be positive, which would make the situation more urgent to get lab testing done to confirm the abnormal results. However, urine or home glucose testing, if negative, would not exclude diabetes.

SS]