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April 2, 2005

Diagnosis and Symptoms

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Question from Lafayette, Louisiana, USA:

I am a diabetic and I have an 11 year old twin girl who had been very sluggish lately and urinating a lot at night. I started taking her blood sugar at night and in the morning. Her readings are 101 to 135 mg/dl [5.6 to 7.5 mmol/L] when fasting and 150 to 170 mg/dl [8.3 to 9.4 mmol/L] at night before bed.

Her pediatrician has sent us to a specialist due to the fact about a year ago because she was losing lots of weight. They found her blood sugar very high then and ran a lot of tests and found that everything came back negative. The specialist told me what to do until he can see us, to check her blood sugars twice a day but be concerned when it is over 150 mg/dl [8.3 mmol/L]. Her appointment is not until four weeks from now. What else can I do? It is easy taking care of myself because I am on medication and I know how to control it. Does a child’s blood sugar run the same as an adult or what is the norm for someone who is not a diabetic? I have been testing her twin as well and her blood sugar stays at 92 mg/dl [5.1 mmol/L] fasting, after eating and before going to bed. I am just very concerned and wondering if I should I to find another doctor who can see us more earlier. I did test her urine at home and found a small amount of ketones in her urine.

Answer:

From: DTeam Staff

While I do not know that your daughter has diabetes, I understand your concerns and feel that she indeed is at higher risk:

she has a first degree relative (YOU) with diabetes;
you have demonstrated some higher readings;
you have demonstrated ketones;
she is having suspicious symptoms with changes in her urinary habits.

Any of these things by themselves may not be so concerning, but the combination certainly brings to mind the possibility of diabetes in your child.

By definition, diabetes cannot be ESTABLISHED with a home glucometer; these devices can screen, but an actual serum glucose, from a sample from a vein, is required. The following are serum venipuncture glucose laboratory values that are consistent with the diagnosis of diabetes:

If the FASTING level is confirmed to be more than 125 mg/dL [6.9 mmol/L]; OR
If a RANDOM level is more than 200 mg/dL [11.1 mmol/L](plus SYMPTOMS); OR
If, during a formal, properly done, oral glucose tolerance test, the value at the two hour point is more than 200 mg/dL [11.1 mmol/L].

Please keep monitoring for glucose levels and ketones and if she has a glucose more than 240 mg/dL [13.3 mmol/L] with ketones and especially if she starts to feel badly with vomiting or breathing heavily/fast with a change in her level of alertness, contact your regular doctor IMMEDIATELY. Otherwise, I think you can probably wait a month to be seen but the specialist will likely order some special tests.

DS