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From Royston, Georgia, USA:

My four year old daughter has been having frequent urination, is constantly thirsty, and she wants to eat all the time. Her fasting blood sugars are any where from 61-171mg/dl [3.4-9.5 mmol/L], and two to three hours after she has eaten, 80-175 mg/dl [4.4-9.7 mmol/L]. She complains a lot that she doesn't feel well or that her head hurts, and when she does, her blood sugar is either over 120 mg/dl [6.7 mmol/L] or lower than 60 mg/dl [3.3 mmol/L]. Her Hemoglobin A1c is okay (5.1%), but her fasting insulin level is 2 (normal:5-27).

Her pediatrician was not concerned, but I asked for a referral because I feel something is not right. I guess the main thing is I don't want to feel crazy for being concerned about this. Is there anything else that can make my daughter's insulin level low? Is there is their another explanation for her blood sugars being from one extreme to the other. Could she have diabetes? What are the diagnosis criteria? We have an appointment with a specialist in a month, but I just need some kind of explanation.


A fasting blood sugar of 175 mg/dl [9.7 mmol/L] in a four year old is abnormal; but you need to remember that at that age the stress of a finger stick in the presence of an anxious mother can raise blood sugars substantially. The random blood sugars are normal, but I think you should ask the doctor to do a full antibody test. If it is positive, you get a head start on the intricacies of management, and if it is negative, you will be reassured.


Additional comments from Dr. Stuart Brink:

Sounds like either an early presentation of diabetes or an atypical presentation. Go to the pediatric diabetes team and get this evaluated since you are correct and this is not normal.


[Editor's comment: See Classification and Diagnosis of Diabetes Guidelines. SS]

Original posting 8 Jun 2003
Posted to Diagnosis and Symptoms


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