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November 30, 2010

Diagnosis and Symptoms

Question from Brisbane, Queensland, Australia:

I am a 40-year-old male with type 1 (diagnosed 25 years ago). Recently, my eight-year-old daughter has been concerning me with her thirst and behaviour. She complains of being thirsty very often but doesn't appear to drink abnormal amounts of water. Additionally, she has a very sweet tooth and can be prone to bouts of lethargy and mood swings. She has always been skinny so there is no obvious weight loss. Her teeth have been very slow to come through; she's lost lots with not much to replace them. So, I decided to use my meter to test her blood sugar. Yesterday afternoon, she measured 7.1 mmol/L [128 mg/dl] after eating a fruit bar. I waited an hour and tested again; this time she was 7.3 mmol/L [131 mg/dl]. The before breakfast reading was 6.3 mmol/L [113 mg/dl]. I then let it go and decided to test her before dinner - 8.9 mmol/L [160 mg/dl]. This seems high to me but I'm not sure. I have always tried to sit in the band between 4 and 8 mmol/L [72 and 145 mg/dl](obviously closer to 4 [72] than 8 mmol/L [145 mg/dl]) and I would have thought that an 8.9 mmol/L [160 mg/dl] was high for a normally functioning child. My plan is to try and get her to my general practitioner at some point this week but I would value an opinion from the team before I put her through the process.

Answer:

You are correct that these are not normal blood glucose readings and these symptoms are suspect. I would suggest that you call your own diabetologist and not the general practitioner and get the name of a pediatric diabetes specialist in Brisbane. I think that Professor Cotterell and his group are there. This will require some pancreatic antibody testing to see if she has any evidence of autoimmunity. It would be helpful for you to do what I call a profile: blood sugar checks before each of the three meals and then about 60 minutes afterwards for a few days to get some sense of the ups and downs with normal eating. Should she start urinating excessively, vomiting or wetting the bed, or unexplained weight loss, then you will need emergency evaluation and more blood glucose testing if this is the early phase of her developing diabetes.

SB