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March 23, 2003

Diagnosis and Symptoms

Question from Castleberry, Alabama, USA:

My almost two year old son weighed 11 pounds, 8 ounces at birth and drinks and sweats a lot. His dad (who lives elsewhere) has type 1 diabetes, has already been in several comas, and is fixing to have a foot amputated. His paternal grandfather also had type 1 diabetes and died at the age of 28. My son's doctor doesn't seemed concerned about the possibility of diabetes and said that the test that could determine if he has it, the Hemoglobin A1c, is not covered by Medicaid, so basically I have to wait for symptoms. Is there anything I can do now to prevent diabetes from happening? I don't want to have to wait for my son to be in a coma to know if he has it or not.

Answer:

I hope there’s an easy answer to the misunderstanding about what test to use to screen for diabetes. The A1c test might be used to help confirm a suspected diagnosis of diabetes, but the A1c (also called HbA1c or glycosylated hemoglobin) is not usually considered as appropriate to make an initial diagnosis. 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. These tests are inexpensive, and should be covered by any reasonable insurance plan if the patient is symptomatic.

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. 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.

No, there’s not much to prevent diabetes. There have been several large studies about prevention of type 1 diabetes, but the results were disappointing. Good nutrition and lots of exercise are always advisable (for everyone!); perhaps having home glucose monitoring supplies available to check blood sugars in specialized situations (such as in the event of acute illnesses, where the stress of the illness might uncover previously undiagnosed diabetes), but not much else.

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