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March 26, 2014

Diagnosis and Symptoms

Question from Albany, Missouri, USA:

My five-year-old son has many symptoms of diabetes, including excessive thirst, frequent urination, and fatigue to the point that he sleeps way too much. He has had two episodes of what has seemed to be hypoglycemia. I took him to his primary care physician (PCP) and she suggested he have a glucose tolerance test and an A1c. They called today and said the glucose test was normal and his A1c was 5.6, and said there was nothing to worry about. But, I checked his sugar with a glucose meter this afternoon and his reading was 195 mg/dl [10.0 mmol/L] about an hour after eating. Should I be concerned or am I just an overreacting mother?

Answer:

The A1c says that his average sugar for the past few months is okay, but the 195 mg/dl [10.8 mmol/L] blood glucose reading is definitely abnormal and suggests diabetes, based on his symptoms and this reading. It is puzzling, if they did the glucose tolerance test correctly, that the tolerance test would not pick this up but that sometimes happens. I would suggest that you talk to your PCP and get a consult with a pediatric diabetes specialist/endocrinologist to review. In the meantime, pay particular attention to the symptoms and if there were weight loss, that would be worrisome and means he would need immediate medical attention. There are special antibody tests (islet, IA2, GADA, ZnT8) that, if positive, would increase the risk that this is all early diabetes developing. Sometimes before the insulin becomes steadily insufficient, causing persistent high sugar levels, there is a period beforehand where there is intermittent insulin excess as the pancreas insulin production is dying and this can cause hypoglycemia for weeks ore months before the high sugars. I would also continue your home blood glucose monitoring so that you are aware of things changing or not as well.

SB

[Editor’s comment: Please make sure that you have consulted a medical professional about how to use the home meter properly, given that you did not explain why you already had a meter. Most importantly, you need to make sure that your son’s hands are clean before you prick his finger.

BH]