May 18, 2007
Diagnosis and Symptoms
Question from Thomasville, Georgia, USA:
My eight-year-old daughter has had some symptoms of diabetes about which I am concerned. She weighs 70 pounds and is very active. Recently, she has been constantly thirsty and hungry. She had some glucose in her urine recently and the pediatrician advised checking her blood sugars periodically. Her fasting blood sugars have been in the range of 100 mg/dl [5.6 mmol/L] to 130 mg/dl [7.2 mmol/L]. She recently complained of a severe headache and I checked her blood sugar, which was 376 mg/dl [20.9 mmol/L]. She had been playing softball and running a lot and had eaten fish and a piece of cake about an hour before I checked it. Since then, her urine has had glucose in it twice and her blood sugars have ranged between 98 mg/dl [5.4 mmol/L] and 172 mg/dl [9.6 mmol/L]. Could my daughter be pre-diabetic and should I be monitoring her daily? Should I ask my doctor to refer her to an endocrinologist or check for insulin antibodies? Can excessive exercise in hot weather cause her blood sugars to be elevated? My uncle was a brittle diabetic and died at an early age due to diabetes complications.
I would recommend bringing this information back to your pediatrician. I would not monitor her daily, but would consider, at this point, doing additional laboratory work to confirm or reject a diagnosis of early diabetes. This may include doing a fasting laboratory blood sugar, a hemoglobin A1c, an autoantibody panel (including GAD, insulin, islet-cell antibodies), and/or an oral glucose tolerance test. It is important to realize that blood sugars measured on a glucometer can be affected by any sugars on her fingers and are only accurate generally within about + or – 15% even when used optimally (good strips, control solutions used, properly coded).
If she is either at very high risk or has newly diagnosed early diabetes I would also recommend looking at the clinical trials available through TrialNet since she might be eligible for some of their studies designed to prolong the amount of time her body makes its own insulin.