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Question:

From Ballston Spa, New York, USA:

My two and a half-year old daughter has been urinating and drinking frequently. I had observed this as did her preschool teacher and babysitter. The pediatrician checked my daughter's urine, which did not have sugar in it so they said she definitely does not have diabetes. However, I have type 1 so, having a meter, and after still being concerned, I checked and got some of the following numbers: 157 mg/dl [8.7mmol/L] after a nap (3.5 hours of no eating), 145 mg/dl [8.0 mmol/L] at bedtime, 232 mg/dl [12.9 mmol/L] 1.5 hours after breakfast, 167 mg/dl [9.3 mmol/L] 1.5 hours after breakfast. I have gotten some numbers in the low 100s mg/dl [around 5.7 mmol/L], but nothing less than 100 mg/dl [5.6 mmol/L]. They're not terribly high, but seem high to me. Although the pediatrician said my daughter does not have diabetes because there is no sugar in her urine, I persisted and insisted on blood work. My daughter's fasting blood sugar was 131 mg/dl [7.3 mmol/L], which they said is only slightly high, so just "keep an eye on her." They're not concerned. Does this sound right to you?

Answer:

Glucose in the urine ("glycosuria") only manifests once the serum glucose is about 180 mg/dL [10.0 mmol/L] or higher. Your pediatrician is misinformed if s/he indicated that lack of glycosuria excludes the possibility of diabetes mellitus. It is a good screen, but not the best screen. By definition, a (confirmed) fasting serum glucose that is greater than 125 mg/dl [7.0 mmol/L] (or greater or equal to 126 mg/dl 7.0 mmol/L]) is consistent with diabetes mellitus. The screening blood checks that you got at home with your own meter are a little suspicious. The fasting blood work, ASSUMING THE SAMPLE WAS DIRECTLY FROM A VEIN AND RUN IN THE LABORATORY AND NOT A METER, is even more suspicious. Your having type 1 diabetes is a real risk factor for your daughter to develop type 1 diabetes.

I do not know if your child has diabetes mellitus or not, and while I do think that your pediatrician is, in essence, correct to "keep an eye on her," I think it would be prudent to make that assessment sooner rather than later.

I might suggest to repeat the fasting SERUM glucose level (thus CONFIRMING the previous elevated fasting serum value that was greater than 125 mg/dl [7.0 mmol/L], i.e., it was 131 mg/dl [7.3 mmol/L]). Again, this should be from a venous sample and run in the laboratory and not a "fingerstick" run a meter. With that blood work, I would probably go ahead and ask that the laboratory analyze the following pancreatic antibodies often elevated in type 1 diabetes: GAD-65 antibody, IA-2 (also called islet cell antibody 512), and insulin autoantibodies.

I am presuming that your daughter is not on ANY medications and is not otherwise ill. If your pediatrician does wish to hold off on testing, then, in the meantime, you might ask for an appointment with a pediatric endocrinologist in your area (likely at the nearest medical school or children's hospital). By all means, if the child begins to have vomiting or diminished levels of alertness, then, given this history, I would want her assessed at that point in the nearest emergency room.

Your pediatrician is your child's advocate and you need a good relationship with them. There is no need to be upset at the approach that has been taken. But you should ask that they become a little more aggressive, given the information that you have in hand.

Many other things can certainly lead to a change in urinary and thirst habits. If your pediatrician believes that this is not diabetes mellitus, then I think the onus is on him/her to figure out the explanation.

Good luck and PLEASE let us know.

DS

DTQ-20100830170811
Original posting 7 Sep 2010
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday September 07, 2010 17:48:10
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