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August 21, 2011

Diagnosis and Symptoms

Question from South Carolina, USA:

My son was found to have sugar in his urine. His blood glucose was 271 mg/dl [15.1 mmol/L], but his A1c was normal. They said he may be showing signs of insulin resistance. His pediatrician ordered that he test his sugar several times a day, watch what he is eating, and exercise, with which I agree, however, the nurse at school doesn't think he should be testing his sugar so often because it could be traumatic. How often should he be testing his sugar in order to see what is going on? I have type 1 diabetes.

Answer:

The school nurse is wrong and the doctor is correct. Information is never a problem, only lack of information is. So, we would usually suggest that islet cell antibody levels be checked because if these were positive then, unfortunately, your son is at high risk of type 1 diabetes developing and you have just detected it at a very early stage. A baseline hemoglobin A1c should be measured. (We would also get lipids, kidney functions, salt levels, thyroid functions and antibodies as well as celiac antibody screen but one could argue that these may be postponed until a later time. Testing should include a detailed profile, i.e., before breakfast, before lunch, before dinner and 1 to 2 hours after each of these three meals. This would define his glucose control at the moment. Pre-meal, normal blood sugars should be less than 100 mg/dl [5.6 mmol/L] and post-meal, normal blood sugar should be less than 126mg/dl [7/0 mmol/L] (perhaps less than 140 mg/dl [7.8 mmol/L] with a home meter system). The measured 271 mg/dl [15.1 mmol/L] is definitely abnormal assuming that it was done correctly. The higher the blood sugars and the more frequently they are abnormal, the more likely that he is developing diabetes. Early detection is thought to help rest the damaged pancreas’ beta cells and prolong a honeymoon period where control is easier to be sustained. The more abnormal the blood sugars, the more you want to consider discussing this with a pediatric endocrinologist/diabetologist or even your own diabetologist, but the physician’s advice you received is right on!

SB