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June 16, 2005

Diagnosis and Symptoms, Other

Question from Houston, Texas, USA:

I have type 2 diabetes and Graves Disease. A couple of months ago our 15 year old daughter was extremely tired and dizzy. Our pediatrician ordered an Epstein-Barr test and an EEG. Both tests were negative and our daughter eventually felt better, but had some episodes of frequent urination. I decided to check her blood sugar and it was 158 mg/dl [8.8 mmol/L] about two hours after eating. I occasionally tested her after that and she had some other elevated postprandial sugars. She had a couple of fasting blood sugars that were normal and a couple in the low 100s mg/dl [5.6 to 6.4 mmol/L]. Then, she had a an allergic reaction and was given a steroid shot. I took her fasting blood sugar the next day and it was 133 mg/dl [7.4 mmol/L]. I called my pediatrician and she ordered several tests. Her antibody test was negative and her two hour glucose tolerance test (GTT) was normal. Specifically, her fasting blood sugar was 93 mg/dl [5.2 mmol/L]; C-peptide 3.1; insulin 12. At two hours, her blood sugar was 86 mg/dl [4.8 mmol/L]; C-peptide 8.8 and insulin level 75. All were verified by repeat analysis. Our pediatrician has referred us to a pediatric endocrinologist. Our daughter is an athlete and has always been active. She is muscular, tall and thin. We have both type 1 and type 2 diabetes in our family. What do you think could be going on with our daughter? Why would she have high insulin levels and high C-peptide levels? Could she be developing type 2? Is it possible it's nothing?

Answer:

Without more details of the preparation and instructions your daughter was given for the OGTT, I lean towards the choice of “it’s nothing.” Could she be a bit insulin resistant and heading towards type 2? Maybe. But, she’s thin and muscular.

There are RARE forms of EXTREME insulin resistance, with high glucose levels, that can be associated with being thin and muscular. An on-going dialogue with your health care team is reasonable, but I don’t think I would do much at this time.

DS