February 21, 2004
Diagnosis and Symptoms, Other
Question from Hesperia, California, USA:
I am at a loss. My eight year old son has Type 1 diabetes. My six year old daughter frequently checks her blood sugars because she thinks that it’s fun. On several occasions, her levels were well over 300 and have even been too high for the meter to read…it just says “HI.” I have had her A1c tested and it was 4.9. I just had her in for an oral glucose tolerance test. Her fasting blood glucose was 82 mg/dl [4.5 mmol/L]. Thirty minutes earlier, her blood glucose was 59 mg/dl [3.3 mmol/L] on our own glucometer. The lab result after one hour was 64 mg/dl [3.6 mmol/L]. After two hours, her blood glucose was 59 mg/dl [3.3 mmol/L]. At home she rarely shows “low” levels. She is almost always high. I always have her wash her hands before the test, have the meter calibrated, and never test her right after a carbohydrate or sugary snack. I am aware of the sudden increase in blood glucose just after eating those. I had expected her lab results to be high, not low. Last night we had a very low carbohydrate dinner at 5:00pm. She only ate approximately 6-10g of carbohydrates. She had nothing to eat after that. At 7:00pm, she tested at 361 mg/dl [20.5 mmol/L]. I am so confused at what her levels mean. The doctors aren’t always “catching” what I see at home, so getting more tests to be done hasn’t been easy.
At six years old, my daughter weighs 40 pounds. She is always hungry and seems to be eating constantly. Recently, she had what was diagnosed as impetigo on her face, skin lesions. She has rotting baby teeth, despite good dental care. She has been wearing glasses for two years and he vision is getting worse. She is Caucasian with blond hair and blue eyes. She is extremely thin skinned, very “veiny” on various parts of her body. She has fits of extreme irritability, anger; she’s very moody. This may seem like a lot of little things, but, maybe if we put them all together, it means something else. Sometimes, I think that the doctors feel that I am just a paranoid mother because I already have a child with diabetes. But, if there is something there, something that I can catch early enough to help, then I want to catch it now.
Answer:
Despite the normal A1c and glucose tolerance test, which make any form of diabetes seem very unlikely, the majority opinion in this clinic would be that it would be wise to have a full antibody test, even though the chances of one being positive is only about 1:20. Her poor growth pattern would be another reason for this. The test involves looking for anti GAD, anti insulin and ICA512 (your doctor will understand what this means): it also requires having the test done by a laboratory that reports its results, not as just a figure; but as +ve or -ve. If any of these tests are positive, in view of her other symptoms, I would ask about getting a transglutaminase test for celiac syndrome as well as a test for hypothyroidism, both of which conditions can be linked to Autoimmune Diabetes in the Autoimmune Polyglandular Syndrome type 2.
I think it is also just possible that your daughter is somehow contriving to contaminate the blood sugar sample because she feels she is not getting her share of parental attention because she doesn’t have high blood sugars. This needs to be approached with the greatest sympathy and reassurance.
DOB
