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April 21, 2002

Diagnosis and Symptoms

Question from Beaver Falls, Pennsylvania, USA:

We have a family history of diabetes, and our almost five year old daughter has always gotten infections easily, bruises and cuts tend to heal slowly, drinks all the time and eats quite a lot of food on occasion. She urinates a lot, wears a pull-up to bed, and is still soaked in the morning. I realize this could just be from so many liquids, but now my daughter has these bouts with fevers and vomiting which she gets over with in 24-48 hours, and then it's like she was never ill. I asked her doctor if she could have diabetes, and he told that with type�1 diabetes she would have had a diabetic crisis, and been very ill almost to a coma state and that she didn't fit the profile for type 2 (She is not obese). So, he offered no testing. Do all children, diagnosed with type 1 diabetes have a very serious crisis before being diagnosed? Can children under the age of five who are not obese have type 2 diabetes? If so, should I find another doctor who is willing to actually do testing to see if this is her problem? I didn't want to jump the gun and have tests done if what her doctor told me was true. I hope you can offer some suggestions.

Answer:

From your description, I don’t think that your daughter has any form of diabetes at the present that needs specific treatment; but in view of the family history I can see why you might be anxious.

First of all, it is almost certain that the family history is of type�2 diabetes. By far the most likely form for your daughter to have if she is from a Caucasian background would be the type�1A (autoimmune) form which has a very gradual onset (usually over several years). The fact that she has had a number of acute intercurrent infections without any exacerbation of diabetic symptoms makes this very unlikely.

However, if you really feel that you have to have an answer, the best, but not completely inviolate method, would be to have a proper antibody test. By this I mean not the immunofluorescent screening test, but the anti-ICA512, anti-GAD, and anti-insulin antibody tests. I can understand that the doctor would feel this to be unnecessary but might be willing to arrange it at your expense if you really felt you needed the information.

A much simpler test of the fasting blood sugar might be done first and be reassuring if it was convincingly in the normal range, but in five year olds there is the problem that the stress of the sample taking can raise the blood sugar significantly. Type2 diabetes at this age is unusual, but not unknown. However, once again, it seems improbable without evidence of being overweight and disliking exercise. There are some more specific tests like a fasting serum insulin level of greater 40 microU/ml, but I would not think this indicated.

DOB