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August 16, 2008

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Medford Lakes, New Jersey, USA:

I asked a question before when all I had were two fasting blood glucoses done at a laboratory. They were 105 mg/dl [5.8 mmol/L] and 106 mg/dl [5.9 mmol/L]. Her A1c was 5.8 and she had a fasting meter reading of 117 mg/dl [6.5 mmol/L] in the pediatrician's office. I originally was concerned because my daughter has celiac disease and, I was told, has small fiber neuropathy in hands and feet. She drinks a lot, wets the bed at night and urinates frequently. Well, I asked if she could be early for type 1 and we got the antibody tests done but they didn't show anything abnormal. The point of concern is we used a friend's meter after a meal. My daughter's hands were cleaned with alcohol. The meter was functioning well and the and strips were new. We got readings after meals of 291 mg/dl [16.2 mmol/L] one time and 265 mg/dl [14.7 mmol/L] two to fours afterwards. She also had a fasting reading of 121 mg/dl [6.7 mmol/L]. The endocrinologist said he can't diagnose diabetes based on meter readings, that he needed laboratory testing to give these results. He is away on vacation now and said to come in next week. In the meantime, I feel like I'm in limbo. Could she not have it or is on her way to getting it, or does she really have it and it's just a matter of having the laboratory do a long term glucose test to prove it? I did read that 30 percent of time, antibodies don't show up, but how, if it's early? Based on what I've told you, what is your opinion?

Answer:

Sorry with the news you have already guessed. These are borderline fasting blood sugars, but definitely abnormal postprandial ones. I think this is early diabetes unless your technique way off. You are also right that antibody tests are only helpful if positive to confirm diagnosis. I would get an A1c, do more blood sugar at home, before and after all meals, for about a week. Then, share with your endocrinologist to decide about food and/or insulin. If you do not currently see an endocrinologist, ask your pediatrician to give you the name of one in your area. If you continue to see elevated blood sugars before your doctor returns, call his office to discuss this. Unfortunately, there are more and more kids with both diabetes and celiac because of common genetic risks. Both can be treated even though it can be difficult.

SB