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February 18, 2010

Diagnosis and Symptoms

Question from Birmingham, Alabama, USA:

My 20-month-old daughter has been exhibiting some of the symptoms of diabetes: frequent urination, constant insatiable thirst, changes in her eating habits, and her lack of weight gain based on her diet. I tested her blood sugar approximately an hour and half after she ate a small lunch and it was 175 mg/l [9.8 mmol/L]. I called the pediatrician and he said the children's blood sugars can spike after meals. I am not comfortable with this considering the other symptoms that have presented themselves in recent weeks. Also, I have had type 1 for 23 years and my other two siblings have it as well. My sister was studied at Johns Hopkins and they declared our genetic strain to be a mutated strain so, I am assuming that this places my daughter at a much higher risk than that of a child without this genetic background. Should I press to have her tested for diabetes because, from what I understand, the earlier the diagnosis, the easier on the body initially? I am worried beyond any reasonable scope at this point and I would like some answers because I don't believe my daughter could run a blood sugar that high from a chicken nugget and a few fries and there not be an issue. She is quite petite, only fifth percentile for her weight but, otherwise, appears healthy. I would greatly appreciate any help or advice concerning this.


Your pediatrician is very correct that blood glucoses can spike after a meal.

If you look at the odds, the chance that ANY child will NOT have diabetes is much greater than the chance that ANY child WILL have diabetes. Your pediatrician, who sees lots of children, is comparing your child to ANY OTHER child. BUT, ANY other child is not YOUR child with the strong family history of type 1 diabetes mellitus.

Because you are very familiar with diabetes, you know that FASTING glucose readings are extremely important in helping to make a diagnosis of diabetes mellitus. Don’t be satisfied with the single post-meal glucose you have shared. Start screening with some fasting fingerstick glucoses AND checking just BEFORE other meals and at bedtime. Gather some evidence and then talk to your pediatrician again over the next couple of days. BUT, if your child begins to have some vomiting or change in level of consciousness, do not hesitate to go the Emergency Room.

In your city, there is a University Medical Center with an excellent pediatric endocrinology division, so IF your child were to be diagnosed with type 1 diabetes, you would have a wonderful resource.

Good luck and please let us know what you find.

By the way, your use of the phrase of “mutated strain” is not completely accurate. Type 1 diabetes is not caused by a “strain” of a virus (mutated or otherwise). What was probably meant was that the genetic profile of some of your family genes is a profile very conducive to the development of type 1 diabetes.