random glucose test for 22 month old diabetic screening?!


Question: Random glucose test for 22 month old diabetic screening?
My little guy has a few medical issues that seem to have a common hormone theme, small phallus, undescended testicle, weight problems, tooth delay, etc... and although we do not get into the endorinologist until July, we do believe hormones are somehow playing a role. With that in mind, at our weight check yesterday I informed the dr. of a sudden increase of thirst and hunger that he has never had before.
He will drink a 6 oz. cup in less than a minute, barely taking the time to breath so he ends up taking a huge gasp of breath at the end, then I'll fill it up again and he will do the same with the next cup, usually a little slower though. This happens 1-4 times a day.
I know all kids eat different amounts and it can come and go in phases, but he has been eating nearly as much as me at every meal plus two snacks a day and a few weeks ago he began waking up in the middle of the night hungry. Despite this, he lost a pound this month. We do have a history of struggling with his weight, but I thought for sure he'd have gained with all this extra food and not really any increase in activity.
So the Dr. sent us over to the lab to have his blood drawn. We had the results back in less than an hour that his levels were normal, but after looking up online it seems like they should have asked when his last meal was, what he had, etc in order to determine what would be normal? I'm not really sure what all they ordered, but is this as accurate as the fasting tests? Do they give the normal results first and have to wait on more?
I will graduate very shortly with my health promotion degree, so while not an expert I feel confident that he is being fed in a way that is not consistent with his weight.

FYI-He has already been tested for nearly all the inborn error of metabolism disorders, even the very uncommon ones. While I am so thankful he does not have any, it is still frustrating to not understand what is going on.

Answers:

Do you have a copy of the lab results with you? If the doctor ordered an HbA1c, then your son didn't need to fast. An A1c is a three-month average of blood sugar levels, so nothing a person eats or drinks that day would affect the outcome.

Random readings and fasting readings are problematic. Random readings tell doctors blood sugar when factors are unknown or uncertain, like when food was last consumed, what the carbohydrate/sugar count of the food was, and so on. Although a very high random reading is more definitively diabetes, borderline readings are harder to diagnose off random readings because the doctor can't be sure of the variables. More importantly, there's a much wider range for "normal" random blood sugar than fasting blood sugar and so your son may have fallen within that range despite not having eaten for many, many hours. For example, imagine I go in for a random blood sugar test at 4 PM and, despite not eating since 7 AM, my blood sugar comes back 123 mg/dL. That might be normal for an RBS, but I essentially fasted for that test and should have been below 100 mg/dL.

Fasting blood sugar is better in the sense that the variables are more controlled (no eating or drinking anything other than water), but diabetics sometimes do have normal fasting blood sugar and very high after-meal blood sugar. Although uncommon, it happens. And this highlights the flaw in fasting AND random blood sugar readings - they are a snapshot in time and don't reveal a pattern of high, low or normal blood sugar.

If symptoms of diabetes persist, like unquenchable thirst, frequent urination, and weight loss, I would push for more diabetes testing, like the A1c and a fasting blood sugar together.



First, about the blood glucose levels - if his was not extremely elevated and your doctor states it was normal, then it is normal. Of course, a fasting blood glucose level would be most accurate but why put your child through another blood test when your doctor is not concerned with his blood glucose levels. Next, at 22 months old, he may be in a growth spurt and they can eat huge amounts of food without gaining weight. When the growth spurt is over, the amount of food he consumes may drop. Next, drinking very rapidly is very common in this age group - they are always in a hurry, exploring their world and to them, you have to drink fast and get back to doing that which is most interesting. Lots of children this age do this AND gasp from drinking so fast. You could encourage him to stop about halfway through the glass of fluid so that he learns he can take a break, breathe and then go back to drinking. This may NOT be related to anything physical going on with him but being 22 months old. Continue to work with your doctors on any continued health concerns and let him be as care-free as possible.

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