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February 27, 2009

Diagnosis and Symptoms

Question from New Market, Maryland, USA:

My six-year-old son has been having a lot of problems with his blood sugar. I was given a meter to test his fasting blood glucose. When I take it, it is usually between 113 mg/dl [6.3 mmol/L] and 126 mg/dl [7.5 mmol/L]. I have told this to his doctor who ordered some blood tests. My son's A1c was 6.0 and they want him to see a dietitian. When my son has sugar, he gets very hyper then crashes and cries and is just miserable so we try to keep him away from sugar. He also gets very miserable and temperamental if he does not have protein every three to four hours. My son is very slim. My mother, brother and grandfather all have type 2 diabetes.

Answer:

I am uncertain what it is that you are asking. Children with diabetes mellitus do not usually get “very hyper then crash and cry” following the consumption of sugary items. The common symptoms of diabetes mellitus are increases in the urinary habits and increased thirst.

Nevertheless, the fasting glucose readings you are getting are suspicious. I sure hope you were given thorough instructions in how to prepare his skin and to prepare the glucose meter properly for glucose checks. Who gave you the meter? Some meters still require “coding” and matching of the test strips to the meter. The skin should be very clean and dry. Remember, glucose meters can be up to 20% INACCURATE so a diagnosis of diabetes mellitus should NEVER be established by a glucose meter. Please see the many questions (and answers) we have posted on the Diagnosis and Symptoms of diabetes.

A hemoglobin A1c (HbA1c or A1c) of 6% is at the upper range of normal, but a diagnosis of diabetes mellitus is also not made on the basis of an A1c value. Certain conditions can lead to false A1c values.

It sounds as if your healthcare team is looking into matters. If they are stumped or uncertain (and certainly if a diagnosis of diabetes is confirmed), you will want to ask for a referral to a pediatric endocrinologist. There are several in and around Baltimore.

DS