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March 20, 2013

A1c (Glycohemoglobin, HgbA1c), Other Illnesses

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Question from Macomb, Michigan, USA:

My 17-year-old daughter has had diabetes for over 10 years. A month ago, we met with her endocrinologist and her HbA1c was the highest it has ever been at 9%. Over the past few months, she has been stressed out over college applications, homework, etc. I attributed her numbers to stress and we made adjustments to her boluses, etc. However, over the past three weeks, she has not been herself with mood swings, a bad temper, and crankiness. She has even acknowledged that “something” is wrong with her.

Her numbers have been okay, with occasional highs/lows. She is very tired all the time and can’t seem to get enough sleep. We had her tested for mononucleosis and strep with both tests coming back negative. The only other strange thing is that her face seems a little puffy. Do you have any suggestions on anything we can do or tests that we should be requesting from her doctor or symptoms we just overlooking?

Answer:

I know you and your daughter want not just “an” answer, but THE answer. This is not a diagnosis that can be made over the Internet.

I’d guess I’d start with a GOOD and complete history and physical (not just “a check-up”) with a clear description to your health care team. Since your endocrinologist knows her best, that may be the best place to start. Offhand, I’d want to know her thyroid status. I’d want to know about her menstrual periods. I’d want to know about weight changes. Other stressors in addition to the ones you “know” about. I’d want to see her meter AND pump downloads to see how she’s been bolusing and checking glucose levels. She needs a good history and physical exam and then presumably some selected blood tests, based on those findings.

Any “stress” (emotional, physical illness, etc.) can impact glucoses as you know.

DS

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