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Question:

From Ann Arbor, Michigan, USA:

I recently wrote a question that was answered. In your answer, you asked a few questions and mentioned some rare conditions. I am hoping that it's okay to follow up on this.

My daughter, who is now 12, is thin. She's 5 feet, 4 inches, and 100 pounds, so she is not at all overweight. She is very active in sports and eats healthy. Her sister and her mother both have insulin resistance, PCOS and are overweight. However, she is not and her menstrual cycle is normal. She does have kidney disease. Preliminary tests for both MODY 3 and MODY 5 were negative.

Her doctor didn't tell us to test both at one and two hours after meals as my other post might have indicated. He wanted her to have random testing at least once a day either fasting, one hour after meals, or two hours after meals, or at bedtime. Usually, those tests are within normal range, although, at times, they have been high. Any blood taken right after a meal, like 15 minutes after she stops eating, have been extremely high, between 190 and 500 mg/dl [10.6 and 27.8 mmol/L].

I am trying to find out if blood taken that close to having eaten isn't accurate and isn't of concern. Her one hour readings are still sometimes high, but never that high, usually 160 to 190 mg/dl [8.9 to 10.6 mmol/L]. Her two hour readings are usually normal. Her fasting is usually normal, 105 to 110 mg/dl [5.8 to 6.1 mmol/L] is the highest. Her bedtime is 140 to 170 mg/dl [7.8 to 9.4 mmol/L].

I am also wondering about the rare conditions you mentioned.

Answer:

Glad to hear the child is thin.

Given the follow-up that the fasting levels have not been elevated and that the two hour levels are not elevated, I feel less concern for any odd, very rare forms of insulin resistance (called lipoatrophic diabetes).

Given my previous response about variable absorption of foods as to how they affect serum glucose levels, I advise that you STOP checking any sugars before one to two hours after a meal. (Again, I prefer the two hour check, but some clinicians prefer a one hour check.)

By checking within 15 minutes of a routine meal (this is to be distinguished from the general advice to check within 15 minutes of treating a low ["The Rule of 15"]), all you are doing is, I fear, is causing anxiety in you and your child.

DS

DTQ-20060116101758
Original posting 19 Jan 2006
Posted to Diagnosis and Symptoms and Hyperglycemia and DKA

  
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Last Updated: Tuesday April 06, 2010 15:10:06
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