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November 6, 2002

Diagnosis and Symptoms

Question from Wichita Falls, Texas, USA:

Question A few weeks ago, the teacher noticed that my friend's four year old daughter had frequent urination so the school nurse did a fingerstick blood test which was 290 mg/dl [16.1mmol/L] about three hours after lunch. By the time her mother picked her up at school and took her to a doctor (general practitioner) about an hour and a half later, her blood sugar was 145 mg/dl [8.1 mmol/L]. He felt that she had a urinary tract infection, placed her on antibiotics, and was not at all alarmed by her blood sugars. He explained o her mother that the 290 mg/dl [16.1 mmol/L] was probably the result of a faulty meter (though the same meter had not previously, nor since, given outwardly skewed numbers), the 145 mg/dl [8.1 mmol/L] was normal, and the frequent urination was due to infection. He also told her not to worry, as Type 1 is not hereditary (uncle has type 1 diabetes). He did an A1c, and said it was normal. I gave her some diabetes information, along with one of our extra meters, and suggested some random testing now that the infection is cleared up. Most first morning numbers are right around 100 mg/dl [5.6 mmol/L], but what concerns me is that two hour postprandial values are 130-150 mg/dl [7.2-8.3 mmol/L]. The girl rarely eats a large meal, but rather numerous small meals during the day. She also is frequently thirsty, but not what I would consider excessively so. I do not want to alarm my friend or cause her undue stress, but I am concerned that this doctor isn't very well versed in type 1 diabetes. Where should she turn next and what tests, if any, would you recommend?

Answer:

Measuring some accurate blood sugars in addition to doing a careful history and physical examination by a pediatrician is likely in this child’s best interest. A blood sugar of 1 145 mg/dl [8.1 mmol/L] is abnormal. Please see Classification and Diagnosis of Diabetes for a more complete explanation of exactly what an abnormal blood sugar is.

MSB