I have two siblings with late onset type 1 diabetes. One was 28, the other 38, when diabetes started. There are also many others in the extended family with type 1 and type 2. My seven-year-old daughter is basically healthy but, over the past several months, has suffered from pallor, tiredness and extreme irritability. Last week, the doctor did some blood tests to check primarily for anemia and CMV (cytomegalovirus). Everything was normal apart from the glucose. She wasn’t fasting (I hadn’t realized they were checking her glucose) and had eaten a bowl of Cheerios an hour before the test. The result was 60 mg/dl [3.3 mmol/L]. My general practitioner feels that this is very normal, that she should just change her diet in order to manage it, and that she needs no further investigations. I understand that the treatment may be appropriate but, given the family history, feel she should be checked more thoroughly. Before I go back and talk to the doctor, I would like to know what you think. If more testing is warranted, for what should they be looking?

A blood sugar of 60 mg/dl [3.3 mmol/L] is a bit low but not diagnostic of anything. After eating, one would expect a somewhat higher value but you also need to know exactly what was eaten, and timing of food and liquids before the glucose result for correct interpretation. If there were symptoms of diabetes in your child, these might include unexplained excess thirst, urination, overnight urination or enuresis and/or weight loss. We usually would, if positive, then check a random, not fasting, sugar level and, if still suspicious, perhaps also pancreatic antibody levels. Normal glucose but positive antibodies would be worrisome and suggest damage to the pancreas and let everyone be alert to a failing pancreas. If there were some symptoms or borderline glucose values (more than 140 mg/dl [7.8 mmol/L], for example) this would suggest a need for home monitoring over several days, checking immediately before the three meals plus one or two hours after meals to see what range exists. IF POSITIVE ANTIBODIES AND/OR HIGHER BLOOD SUGAR LEVELS, THEN CONSULT WITH ONE OF THE MANY EXCELLENT PEDIATRIC DIABETES PEOPLE IN ISRAEL: Dr. Philip and team, Dr. Hochberg and team, Dr. Hirsch and team, etc.

SB