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August 29, 2004

Diagnosis and Symptoms

Question from Smithville, Tennessee, USA:

My seven year old daughter got very weak and almost fainted. She was given some crackers and a cola, which soon made her feel better. She had a glucose tolerance test (GTT) at the family doctor. Her one hour blood sugar was 195 mg/dl [10.8 mmol/L]. At two hours, her blood sugar was 147 mg/dl [8.2 mmol/L] and at three hours, it was 123 mg/dl [6.8 mmol/L]. Fasting blood sugars were 79 mg/dl [4.4 mmol/L] and 85 mg/dl [4.7 mmol/L]. The doctor recommended that we take her to an endocrinologist to determine if she has hypoglycemia, pre-diabetes or type 1 diabetes. My daughter weighs 43 pounds, which is not overweight, and has none of the classic symptoms of diabetes. What do you think of this?


It might be pre-type 1 diabetes that is symptomless, by definition, if you consider the classical symptoms of clinical diabetes though. Even the OGTT (in this case, the two hour reading is somewhat above the normal range of 140 mg/dl [7.8 mmol/L]) is generally not helpful toward this diagnosis. A test for Islet cell antibodies and an IVGTT (intravenous glucose tolerance test) might be much more indicated in order to assess whether there is autoimmune diabetes in your daughter. If those tests are negative, I’d repeat the OGTT with the determination, this time, of insulin response, in order to exclude Impaired Glucose Tolerance (IGT).