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Question:

From Roseville, California, USA:

A friend of mine called me today to tell me about her daughter who went to the doctor due to a stomach ache. They performed a routine urine test and found sugar in the urine. They followed that test with a fingerstick blood test. The result was over 200 mg/dl [11.1 mmol/L]. I asked if her child's finger were cleaned before testing and she said yes. The follow-up appointment was this week and she was instructed to have a twelve hour fast prior to it. This week's urine test and finger prick were negative for any elevated sugars. She thinks her daughter was healed during the past week and I'm concerned for her daughter. Her doctor was surprised by the test results and could not give her an explanation as to why her child's sugar levels were elevated one week ago, but not this week. Can someone with type 1 or type 2 diabetes have an early ability to self regulate their blood sugar prior to presenting fully with the disease? Shouldn't she be concerned that her daughter may, in fact, have diabetes?

Answer:

I understand your concern about your friend's young daughter and it may not be misplaced.

It is important to understand that just as "not all that glitters is gold," similarly, not all that is elevated blood sugar is diabetes (but it very often is). If the little girl in question has had no other symptoms of diabetes mellitus (increased urination, increased thirst, weight change, vaginal yeast infections) and/or has no family history of diabetes then, given the follow-up levels you reported, I'd probably have no other concerns at this time.

It is important to recall that fingerstick blood sugar checking is not the way to make a DIAGNOSIS of diabetes mellitus, in part, because of the inherent roughly 15 to 20% inaccuracy of the small home meters (they are accurate enough to manage day-to-day glucoses in the patient with known diabetes mellitus). Furthermore, it is usually not documented as to quality control of such meters. So, the follow-up test, in my opinion, should not have been a fasting "fingerstick" reading but a genuine needlestick-blood-out-of-a-vein glucose level. If the child had such a serum test and it were normal, then again I'd feel that reassurance is all that is required at this time. But, if the girl has symptoms of diabetes and/or the follow-up test was indeed a fingerstick test, then I think it would be reasonable for another assessment done more formally and properly.

As for the glucose in the urine, remember that glucose typically does not "spill" into the urine from the blood until the plasma glucose level is above 180 mg/dl [10.0 mmol/L]. A random serum glucose value of greater than or equal to 200 mg/dl [11.1 mmol/L] IN THE PRESENCE OF SYMPTOMS is consistent with diabetes. In addition, a fasting serum glucose of greater than or equal to 126 mg/dl [7.0 mmol/L] is consistent with diabetes, also.

Finally, while not wanting to discount anyone's faith, I doubt the little girl was "healed" because you have to first be diagnosed with an illness to be healed from in order to get healed. A diagnosis of diabetes mellitus had not been established based on the information you provided.

I hope this helps you and your friend and her daughter.

DS

DTQ-20091019223327
Original posting 6 Nov 2009
Posted to Diagnosis and Symptoms

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