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September 1, 2000

Diagnosis and Symptoms

Question from Fincastle, Virginia, USA:

We suspect our seven year old may have diabetes. She had a 3 hour GTT [glucose tolerance test]. Her fasting was 40 mg/dl (2.2 mmol/l); one-hour was 201 mg/dl (11.2 mmol/l); one-and one-half-hour was 215 mg/dl (11.9 mmol/l); two-and-one-half-hour was 191 mg/dl (10.6 mmol/l); and three-hour was 154 mg/dl (8.6 mmol/l). I don't know enough about these numbers to know if these point to diabetes, but I do know that she is very difficult to wake up in the mornings and wakes up tired all of the time. She has muscle aches, headaches, and "stomachaches" throughout the day. She breaks out in a cold sweat without warning. Her hands and feet are always cold. She is anxious a lot of the time and suffers from mood swings. She was placed on a "diabetic diet" for two weeks. Then, we are to return for a follow up visit. I am not very comfortable with the way this is being handled. I need help and reassurance that this treated properly. There is a long family history of diabetes, and I have seen how dangerous this can be.

Answer:

First of all, I really don’t understand the GTT times. Standard bleeding times are baseline, and one hour, two hours and three hours after the glucose load. The diagnostic ones are actually the baseline and two hour values. Cutoff sugar values are set accordingly and it’s very difficult to correctly interpret your daughter’s values. Fasting is too low whilst the one-and one-half-hour and two-and one-half-hour values seem high. Moreover, an oral GTT is seldom used in children. An intravenous GTT or a glucagon test along with an autoantibody test are much more useful to make or to exclude a diagnosis of type 1 diabetes in a child. I strongly urge you to ask your doctor for a consultation with a pediatric endocrinologist skilled in diabetes.

MS