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May 26, 2010

Diagnosis and Symptoms

Question from Rochester Hills, Michigan, USA:

My 13-year-old son is growing like a weed, about 4 inches this school year. He has been irritable, tired, going to the bathroom a lot (however, this is not uncommon for him because he has digestive issues and spends a lot of time in the bathroom anyway). Three times this school year, he was sent home from school; the teacher said he was pale and was lightheaded with blurry vision. I decided to check his blood glucose because his sister has type 1 and it has been elevated, about 10 to 15 mg/dl [0.56 to 0.83 mmol/L] above the maximum “normal value” level for the past week and a half. It is elevated by this amount at fasting times and two hours after a meal. I have checked twice at each check and have used two different meters. Can puberty and massive growth spurts account for elevated blood glucose levels in a non-diabetic child? I am going to have him evaluated if these numbers continue, but what other factors could contribute to increased levels over that amount of time? I know stress can elevate it, but my understanding is that it will increase the levels for short periods of time.


From: DTeam Staff

Please confirm that this is correct: your 13-year-old son spends a lot of time in the bathroom, but you do not know if he is urinating more (or what he may be doing) because he has a history of “digestive issues.” He has been tired and more irritable. He is growing taller quickly.

Offhand, without being too “smartalecky,” this sounds like puberty. On the other hand, he has been pale, lightheaded, and had blurry vision at school to the point where he was sent home three times over the past school year (9 months).

His sister had type 1 diabetes which has prompted you to check his glucose on several occasions – fasting and after meals – and the values have consistently been “10 to 15 mg/dl [0.56 to 0.83 mmol/L] above the maximum ‘normal value’.” Since, by current definition, a normal upper limit of a fasting glucose is 100 mg/dl [5.6 mmol/L], then I must assume you are finding values, fasting and two hours after meals, of 110 to 115 mg/dl [6.1 to 6.4 mmol/L]. But the diagnosis of diabetes is made when there is:

a fasting glucose is confirmed over 125 mg/dl [7.0 mmol/L] (“126 mg/dl [7.0 mmol/L] or greater”) OR

a random blood glucose (includes two hour post-meal) of 200 mg/dl [11.1 mmol/L] or more but only with symptoms (I’d expect increased urination and increased thirst but others are possible) OR

a glucose level of 200 mg/dl [11.1 mmol/L] or more at the two hour mark during a proper glucose tolerance test OR

an HbA1c more than 6.5% (new criteria).

Your question focuses on whether puberty and growth spurt or possible other factors could contribute these higher values. I think the biggest “other factor” is that the sibling has type 1 diabetes and this is a risk factor for any genetic propensity. Please talk with your other child’s pediatric endocrinologist about your son. You should probably inquire about the possibility of enrolling your son in TrialNet, which is an international study looking at patients known to be at risk of developing type 1 diabetes with, as an ultimate goal, the purpose of preventing the progression to diabetes.

I would begin to have you observe your child’s drinking habits more carefully and clarify if the frequent trips to the bathroom involve increased need to urinate.”Stress” and a variety of medications can lead to elevations in serum glucose.

A better answer might be possible if you could also give the absolute values of glucose that you have assessed at home.