May 28, 2003
Diagnosis and Symptoms
Question from Detroit, Michigan, USA:
I am a kindergarten teacher, and one of my students has symptoms consistent with diabetes (excessive thirst, frequent urination, itchy torso). His mother has suspected diabetes, but his physician insisted there was nothing wrong with the boy. She finally insisted on a glucose tolerance test, but the boy refused to drink the solution. The doctor is now telling her that there is nothing to be done because there is no other way to diagnose diabetes. This little boy cannot possibly be the only child in the world to refuse to drink this stuff.
Being familiar with diabetes (my father and brother), I am very much aware of the dangers of undiagnosed diabetes. There has to be another way to solve this problem.What else can she do?
It is rarely necessary to perform a glucose tolerance test to diagnose diabetes, especially in a very young child. The “insistence” of performing one makes me wonder many things. In a child of this age group, with the symptoms of increased thirst and urination that you describe, the diagnosis of diabetes can be established either by performing a serum glucose sample (from a vein and analyzed in a hospital laboratory) in a fasting sample or even, perhaps, a random sample. To diagnose diabetes, the fasting level must be more than 125 mg/dl [7 mmol/L] and/or the random sample must be equal to or greater than 200 mg/dl [11.1 mmol/L].
It may be helpful to remember that the increased thirst in diabetes is a compensatory response for all the urination and water loss that occurs as the body tries to rid itself of excess sugar. However. other things can cause these symptoms. Indeed, there are children who for a variety of reasons have an increased thirst, primarily, and then they urinate as a compensatory means of not having fluid overload. In order to see which came first (the chicken or the egg) (i.e the urination or the thirst, sometimes special tests must be run, but establishing or excluding a diabetes diagnosis should be rather simple. If healthcare costs are the issue, there must be a health department which can assist in making this diagnosis.
Additional comments from Dr. Donough O’Brien:
A glucose tolerance test is not needed to diagnose diabetes and the glucose load often makes children sick. A random blood sugar >200mg/dl or a fasting one >126mg/dl is simpler and less expensive; but bear in mind that at kindergarten age stress can raise blood sugars significantly so that an abnormal test would need to be repeated, perhaps adding a hemoglobin A1c test or even an antibody test. Unless this little boy has recently lost weight my guess would be that he does not have diabetes
Additional comments from Dr. Stuart Brink:
It sounds like this child should be seen in consultation either by another pediatrician or by a pediatric endocrinologist. There are several in your area. The school physicians you are affiliated with may be able to make such a recommendation, or you can contact the local American Diabetes Association or Juvenile Diabetes Research Foundation chapter, and one or both can give you some specific consultants names as well. A simple blood glucose coupled with a urinalysis may be all that is needed. If this was already done and negative, then some home testing with a blood glucose meter can also be utilized without having to do a formal glucose tolerance test.