Toddler with diabetes?

[nopun]

I've been describing health problems with my 21 month old on a different thread. After arguments with the GP, we finally had some blood tests done and the results came back today. The GP phoned me and sounded alarmed, which has me alarmed (because they never seem to be worried about anything). I just picked up the new blood test forms and she's written 'urgent' on them - practically unheard of in that GP practice.

His Haemoglobin levels are low (97, when normal range is over 111), and his HbA1c is high (42, when normal range is 20-41).

At first I didn't pay much attention to the A1c. On the phone the GP said it was her fault for not telling me that it was a fasting blood test, and he was eating just before getting tested. Except that I've now looked up the A1c test and it doesn't sound as though you have to fast for it at all!

So how bad is a result of 42? Is he likely to have diabetes? (Also, how do you do a fasting blood test with a toddler still breastfeeding in the night?) And is there anyone here with young kids diagnosed with diabetes who can tell me what it's like? How on earth do you manage?

You're not meant to do the HbAlc test to diagnose/exclude diabetes in children, but only to monitor the management in an established diagnosis. The test should be a fasting blood sugar test. If there were any doubt on the fasting blood sugar test, then the next step is a glucose tolerance test (fast, check the blood sugar, give set amount of glucose, check the blood sugar again).

But if a GP is really worried enough about the possibility of diabetes in a toddler that they're doing bloods, I would actually be expecting them to be picking up the phone to paediatrics at the local hospital, where they would be seen the same day to rule it out.

@nocoolnamesleft thank you for this! I'm now thinking maybe I misheard the GP, and she apologised not for forgetting to tell us about the fasting, but for not ordering the correct test?? Anyway, she has ordered a new one and marked it urgent.

Do you know why the Ac1 isn't used for diagnosing children?

I'm really stressed, both about the potential diagnosis, but also in the short term, how to get the toddler to fast for long enough. He never eats much, but he's a constant he grazer & snacker - he'll go completely nuts if he's not allowed to eat anything. Or have milk in the night.

I'm a bit confused- if the gp now suspects diabetes, why haven't they called you back for an immediate fingerprick blood test?
Anyway, one of my colleagues told me when he was diagnosed his HBA1C was 141, so try not to worry

@InSpaceNooneCanHearYouScream yeah I'm really confused too. These are blood tests I basically had to beg the GP to do, to rule out things like leukaemia or celiac disease. DS has been ill nonstop and not really been himself in weeks. I don't know why she put the HBAC1 on there too, maybe just to be thorough. And when the results came in - showing anaemia & this raised glucose level - , it's the HBAC1 that she seemed particularly alarmed about. I don't know why either!

Thank you, I'm sorry for your colleague but that does make me feel a bit less freaked.

The tests for diagnosing type one diabetes in children is a finger prick of blood to test the blood sugar and blood ketones, and a urine dip to check for glucose and ketones. If diabetes is suspected in a toddler at all, they should be tested straight away. We don't generally fast children if checking for type one diabetes. If the blood sugar is high then there's other bloods that can be sent to the lab but the initial tests are fairly conclusive. If the gp is suspecting diabetes at all, its essential the check a blood sugar today, I would call them back for this, they shouldn't leave you worrying!

Generally, the initial presentation of type one diabetes is loosing weight, an unquenchable thirst, being very tired, and passing a lot more urine than normal.

@IwillrunIwillfly thank you. That is good to know. The GP didn't do either of the things you mentioned (skin prick test or urine test), and diabetes was not mentioned at all, until now. It's very perplexing. Do you think a fasting test is still useful, or rather jumping the gun? I've now got one booked for Wednesday.

I agree, I think the HBA1C is a red herring if he's not losing weight, peeing loads and really thirsty.

As far as fasting is concerned, it's not pleasant having to make a toddler fast, but it is doable. It's unfortunate that he's still feeding in the night-I'm afraid you'll just have to explain he's not allowed any for one night and let him whinge

HbA1c is not used for children, and if you have low haemaglobin your HbA1c will be overestimated