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December 20, 2007

Diagnosis and Symptoms

Question from Poland, Maine, USA:

We have been watching our eight-year-old for diabetes for the past year. We have been checking her blood sugars, which, at times, have been up and down, when she has symptoms of irritability, feels lightheaded, stomachache and nausea. After her flu shot recently, she had a high reading of 193 mg/dl [10.7 mmol/L]. This was about four hours after lunch and a sip of Sunny D. She had no other snacks prior to the reading. We went back to the pediatric endocrinologist who told us that the monitors are not accurate, that they are 30 to 40 points lower than the reading. But, he also told us before that if they were low, then they would actually be 10 to 20 points higher. He also told me her A1c was not normal, but okay. He also said we didn't need to check her blood sugars any more, that she is not diabetic nor will she be, unless she becomes overweight. When she does have a high reading, it does drop quickly by 50 or more points, usually within 30 to 45 minutes. She is currently 48 inches tall and 55 pounds. I am confused why were we checking blood sugars if the monitors are not accurate. I left the office feeling very discouraged. My daughter is constantly not feeling well, pale and crabby all the time. Should I be concerned about her blood sugars or leave well enough alone?

Answer:

Sorry that we cannot make any specific diagnosis with the information you provided, except that the values you presented are clearly not normal. We believe that with reasonable technique, the home blood glucose meters are quite accurate, so I would beg to differ with what you are told. Even if your 193 mg/dl [10.7 mmol/L] value was 173 mg/dl [9.6 mmol/L], this is clearly abnormal. Tracking A1c levels, C-Peptide results and antibody levels would help to understand what is occurring and what needs to be done. Sometimes this is a difficult process because we just do not understand all of this as well as we would like. We would usually continue home monitoring under such circumstances, provide a meal plan that avoids excessive and simple carbohydrates and also would agree that avoiding obesity is extremely helpful. It would also be reasonable to screen for islet cell antibodies, GAD-65 antibody and IA2 antibodies. If negative, this will not be helpful; if positive, this would indicate current autoimmunity and high risk of future insulin dependent diabetes. There are also some other types of rare forms of diabetes that would require specific and expensive genetic tests (MODY variants, for instance). I would suggest going back to your diabetes team and ask for an in-depth conference so that you can ask these questions and create a follow-up plan that makes sense to them and to you as well. Alternatively, you may want to seek another consultation for a second opinion.

SB