My ex-husband has severe type 2 diabetes. Our four year old son wanted his sugar checked recently after a meal, and it was elevated (about 190s mg/dl [10.6 mmol/L] ), so he asked me to get a meter and check my son’s sugar over time.His fasting sugar is fine (98-102 mg/dl [5.4-5.7 mmol/L] ), but about three hours after a meal yesterday, his sugar was 219 mg/dl [12.2 mmol/L].

I immediately called the pediatrician, who said that “random tests” do not matter, that if his fasting readings were not high, then there was not a problem. Within 45 minutes, his sugar was back down to 113 mg/dl [6.3 mmol/L]. However, on looking on the ADA website, I saw a notation that any blood sugar reading over 200 mg/dl [11.1 mmol/L] is considered to be a diabetes but that the results would also need to be confirmed with fasting sugar readings and the oral glucose testing. Should I be panicking right now? Should the pediatrician be concerned? If so, how do I get them to do what is appropriate?

I do not think you should be panicking! At present, I do not think a formal oral glucose tolerance test is required. Your interpretation of the Classification and Diagnosis of Diabetes is not quite on target. A random serum glucose (this means by a needle stick from a vein and analyzed in a proper laboratory – and not a fingerstick with a glucose meter) of greater than or equal to 200 mg/dl [11.1 mmol/L] and concurrent symptoms of diabetes is consistent with a diagnosis of diabetes. Common symptoms would include increased thirst and urination.

If your son’s father truly has type 2 diabetes, and your son is without symptoms and is thin to average weight, I think the likelihood of diabetes in your son is low.

The pediatrician may want to send you for a “poor man’s glucose tolerance test” (not entirely accurate but reflects the real world: get a fasting serum glucose level at the hospital lab (from a vein and run on a glucose analyzer) and then send the child off for a hearty breakfast full of carbs (e.g., pancakes, juice, toast, cereal, milk) and then repeat the serum glucose at the lab (from a vein) two hours after the meal. (You don’t want the meal to last two hours but you want to check the glucose two hours after “the first bite.”

DS

[Editor’s comment: As Dr. Schwartz points out, testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal.

Occasionally, lab blood sugar testing might be normal in an early case of diabetes, repeat blood sugar testing at the same or a different time, or performing a glucose tolerance test, might be appropriate if there is a high suspicion of diabetes despite normal initial testing. Another test, the A1c, might be used to help confirm a suspected diagnosis of diabetes, but the A1c (also called HbA1c or glycosylated hemoglobin) is not usually considered as appropriate to make an initial diagnosis. Antibody testing is occasionally done as a screening test in high-risk situations, or as confirmatory of type 1A (autoimmune) diabetes, but is not part of routine testing.

Urine sugar tests or home glucose testing, if done, might be positive, which would make the situation more urgent to get lab testing done to confirm the abnormal results.

WWQ]