September 2, 2003
Diagnosis and Symptoms
Question from Australia:
My daughter who is very overweight is in hospital, and her doctors told us that she has (in normal range) a high level of insulin. They have done a glucose tolerance test and said that her sugar levels went up very high and that she has a serious problem. They are going to ask the endocrine doctor to review her. I asked if she had diabetes and they said no. However, all the information I have read on hyperglycemia refers to diabetes. Do you have any information?
Answer:
I recognize that you do not have specific information to share at this time, such as the specific blood test results. Just as “not all that glitters is gold”, not all that is elevated blood glucose is diabetes mellitus, but it usually is. Please see Classification and Diagnosis of Diabetes Guidelines. and symptoms of diabetes. By current standards, diabetes mellitus is defined as:
a fasting serum glucose (from a vein — not a fingerstick) that is greater than 125 mg/dl [6.9 mmol/L]; or
a random serum glucose (from a vein — not a fingerstick) that is greater than or equal to 200 mg/dl [11.1 mmol/L] if there are classic symptoms of increased urination, thirst, weight changes, etc; or
a serum glucose value (from a vein — not a fingerstick) that is greater than or equal to 200 mg/dl [11.1 mmol/L] at the two-hour mark during a formal, properly done oral glucose tolerance test.
Based on your description of the high glucoses but that she does not have diabetes, and her obesity, I am presuming that your child has glucose intolerance — a “prediabetes” condition, if you will. Weight loss is the issue.
In the obese teenage girl with what you describe, it may be important to look for evidence of Polycystic Ovary Syndrome. The doctors may also be looking for a condition whereby the body produces excess cortisol hormones. These are conditions that can be associated with hyperglycemia, and while the former is often associated with type 2 diabetes, the latter is treatable — treatment depending on the cause — and one would then expect the high glucose levels to resolve. But excess cortisol is rare.
DS