In July 2007, my toddler son got into my mother’s diabetes medication. We couldn’t find one of the pills, but weren’t sure if had taken it or if it was just lost. So, we took him to the Emergency Room where he was monitored overnight. His blood sugar was fine until 9 a.m. the next morning when it was elevated. The doctor decided to order a GTT.

They did the GTT at the hospital. My son had to drink a few ounces of soda (7-Up or Sprite) within five minutes. Thirty minutes afterwards, his blood sugar was 215 mg/dl [11.9 mmol/L], without drinking anything else. The pediatrician said anything over 200 mg/dl [11.1 mmol/L] is classified as diabetes. If my son were allowed to drink water in the 30 minutes, I’m sure his blood sugar would have been lower. They didn’t finish the test since the first test was high right at the start. The pediatrician also said he would refer us to an endocrinologist if my son’s blood sugar were consistently over 200 mg/dl [11.1 mmol/L].

My son does drink a lot so, in turn, he urinates a lot. But, I’m not sure if it’s not just out of habit. He always carried around his bottle or sippy cup, but since he has been switched to a regular cup, he doesn’t drink nearly as much. He is not overweight; he is underweight. He has always been small since birth. He was born at 38 weeks, and weighed 4 pounds, 15 ounces. Now three, he weighs 30 pounds.

At home, his blood sugar has been over 200 mg/dl [11.1 mmol/L] a few times. I have been trying to control his diet by limiting his carbohydrates, but he isn’t gaining weight. How many grams of carbohydrates should he eat in a day? Do I need to check his urine? The doctor has not mentioned this. He did suggest that I check my son’s blood sugar an after meals. I thought people with diabetes check two hours after meals. Which should I be doing?

You and your son’s doctor need to step back a little.

First of all, your son’s doctor may have mistakenly given you some advice out of context as to what DEFINES diabetes mellitus. You can read more at our web page on the Classification and Diagnosis of Diabetes but, in brief, diabetes mellitus is made when any of the following can be established:

When the FASTING serum or plasma glucose (checked in the laboratory and not a “fingerstick”) is CONFIRMED on at least two occasions to be MORE than 125 mg/dl [7.0 mmol/L] (“equal or greater than 126 mg/dl [7.0 mmol/L]”) OR:

When a RANDOM serum or plasma glucose (checked in the lab and not a “fingerstick”) is greater than or equal to 200 mg/dl [11.1 mmol/L], but in the appropriate clinical context of diabetes SYMPTOMS OR:

When a PROPERLY performed oral glucose tolerance test demonstrates a serum or plasma glucose (checked in the laboratory and not a “fingerstick”) of equal or greater than 200 mg/dl [11.1 mmol/L] at the two-hour mark.

A proper glucose tolerance test is far different than what you describe your child underwent. It involves special preparation of the child: (they should consume at least 60% of all the calories as carbohydrates for the three days before the test and the child should then not have anything to eat or drink for night before the test is done (about eight hours). There is a specified load of glucose to be given: 1.75 grams per kilogram of body weight (to a maximum of 75 grams of glucose), which should be consumed relatively quickly! The serum or plasma glucose (checked in the laboratory and by a “fingerstick”) is checked typically at 30 minutes, 60 minutes, and 120 minutes (two hours) after the first sip of the glucose. It is the two hour mark that helps define diabetes.

So, I might suggest that you start with a clean slate and a start fresh. A referral to a pediatric endocrinologist might allow some relief.

Now, I am not your child’s doctor, but personally, I would liberalize the diet to “normal” and then screen with a reliable fingerstick meter at home, being sure that the glucose test sites are clean and dry each morning BEFORE breakfast, and then perhaps BEFORE lunch and dinner and bedtime for a couple of weeks and see what the values show.

Good luck and let us know what you find.

DS