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Question:

From Iuka, Mississippi, USA:

I took my eight-year-old daughter to the pediatrician last week and insisted on a blood sugar test because I had noticed some symptoms that had me slightly concerned, including getting up five or six times a night to get a drink of water. At 4 feet, 4 inches, she weighs 97 pounds and was complaining about being thirsty all the time. She also has an insatiable appetite. She gets very emotional, crying over nothing when we are late eating a meal. Her blood pressure was a little high, 110/68.

I have a thick family history of type 1 diabetes, so I thought it best to get her tested if I had any doubts at all. Her fasting blood sugar was 120 mg/dl [6.7 mmol/L]. That is all I was told. Her doctor said that was not good and considered "borderline." He wants us to watch her diet for the next month and take her back for a recheck on the 18th. I don't know what sort of testing equipment they used; all I know is that they took two vials of blood from her arm. What exactly does borderline mean? Does that mean she could be developing diabetes? Is the one month wait standard and is he doing that because he thinks her diet is causing this? Are there any other tests I need to be requesting?

Answer:

We receive many questions regarding how the Diagnosis and Symptoms of diabetes mellitus is made and how to interpret glucose levels. You might want to review some of those.

For an eight-year-old, your daughter, at 97 pounds, seems rather overweight. Her height, 52 inches, would be near average for her age (if I interpreted what you wrote correctly).

You indicated that she has increased urination, increased thirst, and increased, insatiable, appetite AND a strong family history of type 1 diabetes. It might be helpful to learn more details of this family history, but given what you have provided, I also would be concerned about diabetes mellitus in your daughter -- either type 1 or possibly type 2, since she seems overweight.

Based on your description of vials of blood being drawn, I will assume that her serum glucose was measured formally in a laboratory, which is best. Therefore the fasting value of 120 mg/dl [6.7 mmol/L] is indeed "borderline" as your doctor indicated. A normal fasting serum glucose level is about 60 to 100 mg/dl [3.3 to 5.6 mmol/L], HOWEVER, diabetes is not diagnosed until the fasting serum level is greater than 125 mg/dl [7.0 mmol/L] ("equal to or greater than 126 mg/dl [7.0 mmol/L]"). Therefore, fasting glucose values between 100 and 126 mg/dl [5.6 and 7.0 mmol/L] are considered "borderline" and often described as being "impaired fasting glucose" or "pre-diabetic."

Waiting a bit and repeating the values is not at all unreasonable, depending on what other blood tests may have been ordered by the doctor with those vials of blood. Would I wait a month with those symptoms you describe? No. Adjusting the diet, which should include lowering the carbohydrate intake, is also reasonable and he may be doing that first because he might suspect type 2 diabetes in your daughter. Nevertheless, despite the increasing incidence of type 2 diabetes in children, type 1 remains the most common.

I'd probably ask the doctor if he might have measured the following on the original vials of blood: 1) Hemoglobin A1c 2) Any "anti-pancreas antibodies" 3) and whether he measured for ketones in the blood or the urine at that first visit. If the answer is 'NO' to those questions, then I'd ask to bring her back sooner for the repeat fasting test. If the answer is 'YES' to those questions, and the results are out of range, then the diagnosis of diabetes may already be confirmed and you need not wait. Either way, you might ask for a referral to a Certified Diabetes Educator to instruct you in proper home glucose monitoring and an appropriate and balanced meal plan for your daughter. The meal planning will help if she has type 1 or type 2 diabetes or even for "pre-diabetes" because of the need for weight control.

Pre-diabetes is potentially reversible, although the degree of intervention would depend if she is at higher risk of type 1 versus type 2. If she has anti-pancreas antibodies but does not yet have full-blown type 1 diabetes, ask your doctor to refer you to a TrialNet site as there are Diabetes Prevention Trials for which she might qualify.

DS

DTQ-20091026154419
Original posting 2 Nov 2009
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:10:20
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