April 4, 2009
Diagnosis and Symptoms
Question from Huntington, West Virginia, USA:
My nine-year-old son has been experiencing an intermittent “quaky” feeling for almost two years. When he first began complaining, his doctor ran all of the common tests, fasting glucose/fasting insulin/thyroid panel, etc. The insulin was on the low side, but everything else was fine. We were told to check his blood sugars intermittently for lows and give him small, frequent snacks/meals. He would experience problems maybe one to three times a month.
Fast forward to a couple of weeks ago. The “quakiness” began happening more frequently. We took him back to his doctor who ran an A1c (5.3) and normal fasting glucose. The doctor recommended doing a fingerstick when my son had problems to try to catch a low. Last weekend, my son complained, so I did a stick and it came back at 148 mg/dl [8.2 mmol/L]. That made me a little nervous, so the next day, I checked about an hour after he ate breakfast–250 mg/dl [13.9 mmol/L]! An hour later and the rest of the day, his blood sugar was normal. After supper, it again spiked to 280 mg/dl [15.6 mmol/L]. As far as we know, though, his blood sugar has been normal since then, for five days, with a fasting high of 107 mg/dl [5.9 mmol/L] and a couple of random 140s mg/dl [7.8 to 8.2 mmol/L]. We are currently checking a fasting glucose in the morning when he acts “off” or complains. Our family doctor is baffled and is trying to schedule us with a pediatric endocrinologist.
My son is very tall and very slim. Have we just caught type 1 diabetes extremely early or is this something else? I just need to know we’re not alone.
Answer:
While it is possible that you have caught early type 1 diabetes, this wouldn’t be top billing for considerations. Please see our web page on the Classification and Diagnosis of Diabetes to help you understand what criteria define the diagnosis of diabetes. It does NOT include testing with a glucometer.
Be sure you bring your home glucose meter with you to the endocrinologist’s office. I hope that your technique for checking glucoses at home is correct with careful washing and drying of the skin prior to testing (or using an alcohol wipe but still allowing skin to dry completely) and the meter is using the proper test strips. Some meters still require “coding” of the meter to the test strips and if you don’t, the meter reading will be erroneous. Correct technique is paramount. Check with the doctor’s office to make sure you are using the glucometer properly.
Depending exactly on when the glucose readings were done relative to meals, then some of your readings don’t bother me at all. I definitely agree with your doctor: the only way to help “prove” that your son’s “spells” are related to low glucose is to detect a low glucose at the time of the spell. I typically ask my families to go one step further. In addition to checking during any spells, I also have them check glucose routinely before breakfast, lunch, dinner, and before bed for two to three weeks.
DS
