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Question:

From Coldwater, Michigan, USA:

A friend's daughter, age 10, has had blood glucose levels going up and down. It is always normal in the morning or fasting, but is high after meals. It has gone to the 300 to 400 mg/dl [16.7 to 22.2 mmol/L] range directly after meals, but always falls back to normal range. It usually is in the 150 to 170 mg/dl [8.3 to 9.4 mmol/L] range one hour after meals and 80 to 100 mg/dl [4.4 to 5.6 mmol/L] before meals. She has had glucose in her urine on occasion. We found this because she had a urine test for an infection, then the doctor had her mother monitor her blood sugars. Her A1c is 5.1, which is totally normal, therefore the doctor says not to worry, but continue to dip her urine once a month.

I read this on a web site about high post-meal blood sugars: "The "Normal-Max" response means you are already well started on the road to diabetes. This is "normal" but it is not good. You are aging faster than the minimum possible. Your pancreas is still releasing enough insulin, but maybe 10% to 30% of your beta cells are not functioning. The stream of insulin is not as much as it was before which is the reason why glucose is rising. You should care for the remaining beta cells by not stimulating release of insulin. To prevent the advance to diabetes, pretend that you are already a diabetic, and start to take care of yourself as if you are a diabetic... Eat like a diabetic... Cut down drastically on carbohydrates."

The "Normal Max" response they were referring to was anything over 140 mg/dl [7.8 mmol/L] after meals. Does this mean that this child is on the road to diabetes? Could the A1c be reflective of hypoglycemia, since it equals a blood sugar of 96 mg/dl [5.3 mmol/L], yet she is often in the 150 mg/dl [8.3 mmol/L] and above range? Does that mean she must also drop down in the 40 or 50 mg/dl [2.2 or 2.8 mmol/L] range on occasion? Should her mother treat her as hypoglycemic or a prediabetic? Her mother is worried.

Answer:

The Internet is a wonderful resource, isn't it? There is so much information! How can you discern the truth from the nearly truth? Remember that no one filters or scientifically reviews someone's personal web site. I can put on my web site that the moon is made of green cheese. Heck, a million people could say it! But, it would not make it true.

The source that you are quoting from the Internet is not completely off base, but it is not entirely true to current standards either.

Please review our Classification and Diagnosis of Diabetes page.

Having prefaced with that:

A normal fasting serum glucose (through a real vein puncture and analyzed in the laboratory) is generally between 60 and 100 mg/dl [3.3 and 5.6 mmol/L]. A confirmed fasting serum glucose more than 125 mg/dl [6.9 mmol/L] is consistent with diabetes.

Home glucose monitors are extremely helpful, but they can be off by near 20%. One would not want to make a diagnosis of diabetes based on a meter. There are many, subtle, logistical and technical variables to align in order to assure the most accurate result.

A RANDOM serum glucose level greater or equal to 200 mg/dl [11.1 mmol/L], in the presence of classical diabetes symptoms also defines diabetes.

And, a glucose level of greater/equal to 200 mg/dl [11.1 mmol/L] at the two hour mark in a properly performed, formal oral glucose tolerance test also defines diabetes.

So, your friend's child has had sporadically high glucose levels, probably checked with a home glucometer. She has had intermittent glucose in the urine. Her A1c is reportedly normal (NOT a good screen for a diabetes diagnosis). She apparently has no symptoms. You did not describe whether she was heavy, did you?

Could she have glucose intolerance, a "pre-diabetic" state? (I dislike that term.) Maybe. If there are real concerns, then the proper glucose tolerance test might be required. It usually is not. In order to decide to treat her as glucose intolerant or not, is to establish a diagnosis.

BUT, if she is heavy, then dieting would not necessarily be unreasonable. The family might do well having a consultation with a pediatric endocrinologist or at least a pediatrician well versed in glucose issues. A generalist or family practitioner may not be up to speed here yet.

DS

DTQ-20040929144202
Original posting 30 Sep 2004
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:58
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