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From North Carolina, USA:

I have a 9 year old son that does not gain weight at the pace that his friends do. I checked his sugar level with a finger prick system that a diabetic friend has. His sugar level was 169. I called his pediatrician and the nurse indicated no urgency. I made the first available appointment -- almost a month away. She told me to monitor his blood levels until the appointment date. Should I take him to another doctor or should I calm down? Also, does his birth weight have anything to do with developing diabetes (his birth weight was 9 pounds 12 ounces)?


A blood sugar level of 169 mg/dl sounds high; but it is not beyond the limits of what might be seen in a normal child where a) the sample had not been taken fasting, b) the measurement was made by someone unaccustomed to reading test strips or using a reflectometer and c) there may have been quite a lot of spoken and unspoken stress surrounding the test and the implications of what it meant.

By now, you have probably taken one or more morning fasting blood tests and if the levels you obtained were above 120 mg/dl and especially if you also tested a urine sample and found both sugar and ketones you should contact the pediatrician's office again and, if possible without a confrontation, insist on an appointment. At the same time it would be wise to locate the nearest children's diabetic team, that is, a group in which there is not only a physician, but also a nurse educator, a nutritionist and perhaps a medical social worker. One way or another and for your own peace of mind too, you need to solve this issue and it is possible that other tests such as measurement of an antibody level may be suggested. Having said all this, you should know that the dangers of delaying a few days are small unless your son develops an infection. The onset of the clinical phase in autoimmune diabetes is usually both intermittent and gradual.

As to the growth problem, the first step is to look at serial measurements of height and weight, usually recorded as a 'growth chart'. Your pediatrician, especially if you have been to him for some years, is almost certain to have one and if not it would be helpful to mobilize any records that you yourself may have kept. Looking at such a chart will help to decide whether he is someone who is quite normal; but who has always been small; i.e. always on the third percentile or whether there has been a significant fall off in growth at some stage which needs to be further investigated. Any specific relationship to diabetes is improbable except for a very recent loss of weight, though later on in diabetes growth failure can represent poor control or an associated thyroid deficiency.

Take heart, these sort of situations are not uncommon, and even if your son does turn out to have diabetes, you should know that enormous progress has been made in the last few years towards better and easier management and that he should be able to plan an essentially normal if rather more disciplined life.


Original posting 27 Sep 97


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