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January 13, 2010

Diagnosis and Symptoms

Question from Lititz, Pennsylvania, USA:

About two and a half weeks ago, my 12-year-old daughter began to look extremely pale with a grey cast to her. About a week ago, she began to complain a lot about excessive thirst, hunger and fatigue. About two days after that, she added headaches, blurry vision, her bones hurting, cramping in her stomach, getting up two or three times a night to use the bathroom and tingling in her feet and lower legs. I know these are all symptoms of type 1 diabetes. I took her to the pediatrician and her urine was negative for sugar. The doctor sent us for a round of blood work (not fasting) that all came back normal. I asked the doctor what the next step should be and she told me she felt this was not biological but, rather, a mental issue and I should talk to her therapist. I responded by saying that I didn't feel she could fake being grey/pale and just happen to pick all the symptoms of diabetes (she didn't even know what that was). The doctor said she didn't believe my daughter was faking, just that it was in her head. After speaking with her therapist, who was outraged, as well as the diabetes clinic, I was advised to insist on a glucose tolerance test. The doctor did order the test, a three hour fasting test. I spoke to the doctor this morning and she stated that my daughter's fasting level was normal, but her one hour was way below normal. She admitted she doesn't know much about this and had a call into the endocrinologist, but really still felt that this was an issue for her therapist. I know my child and something is very wrong. She gets worse each day. I'm not sure what to do at this point. Is it possible she is in the beginning stages of developing type 1? Any advice as what a next step might be?


It is difficult to make a solid suggestion of medical care without knowing specific glucose values and the specific circumstances regarding the oral glucose tolerance test (preparation, dose of glucose, method of glucose measurement) and more regarding your daughter’s medical and psychiatric history.

Some of the symptoms you describe are consistent (not necessarily diagnostic) with a diagnosis of diabetes mellitus, but the absence of high glucose readings on the glucose tolerance test would certainly tend to limit that possibility. A “low” glucose value at the one hour mark does not make a lot of sense and, while possibly consistent with some of her symptoms, is certainly not consistent with the increase in thirst and bathroom habits.

Unless your internist’s consultation with the endocrinologist sparks a diagnostic evaluation, then I’d guess a good place to start is to ask for a second opinion and full “new patient history and physical” from a local respected pediatrician. Make an appointment so that you can have the full time needed to address these issues. I am biased and believe that children should be seen by pediatric providers whenever feasible.