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Question:

From Somerset, Kentucky, USA:

I picked up my two and a half year old daughter from day care. The teachers reported that she picked at her lunch, and when they sat the children down for snack, a teacher noticed my daughter shaking/trembling. They gave her the snack, (peanut-butter sandwich), and the shakes went away.

The next morning I took my daughter to the doctor, and her fasting blood sugar was 197 mg/dl [10.9 mmol/L] on the glucose monitor. The next day she I had her scheduled to have blood drawn for the test that will check for the past three months which was normal, and before drawing blood they did another finger stick, again on an empty stomach, which was 89 mg/dl [4.9 mmol/L]. Her doctor says there is nothing to worry about, but my daughter drinks all the time. It doesn't matter what it is -- she will drink it, and I get up twice during the night to take her to the restroom.

A week or two after we had found this out, I walked into my daughter's room, and she was laying in her bed, watching TV, I could smell urine. I reached down to check her, she was soaked with urine and her head was wet with sweat. My daughter is potty trained, and she doesn't like to be wet.

Should I be worried? Is my daughter's doctor right? Should I ask her doctor to give us a referral to a specialist?

Answer:

The test that you referred to is called the "glycohemoglobin test" or sometimes referred to as "hemoglobin A1c (HbA1c)". It measures the percentage of glucose sugar that is "stuck" to the blood protein hemoglobin. Since it takes up to four months for hemoglobin to be "recycled", about half of the circulating hemoglobin will have glucose stuck to it, so the HbA1c can "average" the degree of glucose in the blood for the previous 8-12 weeks. One cannot establish a diagnosis of diabetes with the HbA1c test. If her symptoms are very recent in onset, the HbA1c may not yet be elevated.

With the symptoms that you describe her as having, I would still consider diabetes mellitus ("sugar diabetes") as a possibility. Some fasting glucose readings (done on a venous sample run in a lab, not a meter at this point), and even some values two hours after a hearty, starchy breakfast seem reasonable to me. Rarely, a formal glucose tolerance test is required (and even so, it must be set up rather specifically for a child, differently than for an adult or pregnant woman.)

There are other conditions that can lead to changes in bathroom habits and thirst, one is confusingly called "Diabetes Insipidus" which has nothing to do with sugar problems. I think you and your physician would be wise to continue to try to track this down, and a referral to a pediatric endocrinologist may be a good idea.

DS

DTQ-20020311194443
Original posting 30 Mar 2002
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:32
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