Best way to diagnose in a 4 yr old?

[Nict]

Hi. Just after some advice. My 4yr old is having a hba1c on Wednesday. However, am I right in that he should having a fasting blood test instead? Thanks.

 

[Martin Canty]

Hi Nict,

The HbA1c test is an average over the last 3 months, fasting is not required for this test. The FBG test tells you what it is right now....

 

[HOBIE]

You must have been talking to a T2. They get them but not so much T1. Let us know how it goes pls Good luck 🙂

 

[Nict]

He's had a couple of episodes recently (clammy pale, feeling sick (not sick) and falling asleep soon after. He also had +++ketones in his urine after his last episode) and asked my gp to test him. She thought he was a bit young to show symptoms!!, but booked him in for hba1c. I don't want him having unnecessary tests. Should I ask for a fasting instead?

 

[HOBIE]

They will be able to test straight away. Do you know what a fasting blood test is ? & why do you want this done ?

 

[Redkite]

Is he type 1? Or are you thinking he might be? Symptoms are the four T's - toilet, thirsty, thinner, tired. A child presenting with those symptoms, even if he/she seems well, should be given a simple fingerprick test for blood glucose level - no need for fasting tests. Hope it's not type 1, doesn't sound like it tbh.

My son was aged 4 on diagnosis - he had been drinking more than usual (though I'd put that down to hot weather) and was getting up 4 or 5 times in the night to go for a wee. He was exhausted and had no energy. I didn't realise he'd lost weight until I compared recent photos, but he had actually lost about 10% of his body weight in just a few days. The symptoms tend to come on very fast and dramatically in young children

 

[Sally71]

No definitely do NOT waste time having fasting tests! If you think your little one may have diabetes then you need to know as soon as possible. Both blood glucose level and HbA1c are a simple fingerprick test with no need for fasting and the results can be given almost instantly.
Fasting tests are correct to diagnose type 2 in an adult but Type 1 is a completely different beastie

 

[trophywench]

Noooooo!! - why the hell hasn't the surgery done a fingerprick blood test immediately? He may well not like having his finger pricked but it's a pinprick of blood needed and one heck of a lot less traumatic for anyone of any age, than drawing blood from a vein.

Feeling nauseous and dropping into a dead sleep is a really common sign of impending diabetic ketoacidosis at any age - and providing the person still has some insulin circulating, providing it's still enough - well you do wake up. But where you don't have enough insulin circulating you won't - it's a diabetic coma, and you don't wake up without immediate emergency treatment in A&E !

If we think he might be Type 1 - and we do! - there is no need to fast.

As it is you'll get the results by Thursday - unless his A1c is already too high - in which case you should get a phone call very soon after the blood gets to the lab and is tested to take him to hospital immediately - for a child his age, a high result should be reported straight back to the GP surgery and they should act on it immediately and ring you.

 

[Diabeticliberty]

Does he seem to be very thirsty a lot lately?

If you want an instant result you could go to Boots or any pharmacist tomorrow morning and pick up a blood glucose test meter for under twenty quid, test him yourself there and then and you have a result

 

[Redkite]

No definitely do NOT waste time having fasting tests! If you think your little one may have diabetes then you need to know as soon as possible. Both blood glucose level and HbA1c are a simple fingerprick test with no need for fasting and the results can be given almost instantly.
Fasting tests are correct to diagnose type 2 in an adult but Type 1 is a completely different beastie

Only paediatric units in hospitals can give you instant Hba1c results (using machines which read plasma glucose). The machines are expensive and adult clinics are not equipped with them. The GP will be sending a whole-blood sample to the lab, which will take days to come back with a result. Don't wait for this, ask for a fingerprick blood glucose test.

 

[Nict]

I am concerned as to if he is type 1. He has had a couple of such episodes and with the ketones I was worried. I've had to get him twice from pre school because of them as he went unwell.

So, should they just do a finger prick then?

Thank you.

 

[Redkite]

I am concerned as to if he is type 1. He has had a couple of such episodes and with the ketones I was worried. I've had to get him twice from pre school because of them as he went unwell.

So, should they just do a finger prick then?

Thank you.

Yes they should if type 1 is suspected. Do the symptoms you've described come and go? Has he been ok in between?

 

[Nict]

They do come and go....but he does wake with night sweats every now and then too, I put down to a dream as he wakes a bit dazzled and shakey but my mind obviously is on overdrive.

 

[Martin Canty]

but he does wake with night sweats every now

This can be another symptom, I used to soak many pillows before DX.....

 

[Redkite]

They do come and go....but he does wake with night sweats every now and then too, I put down to a dream as he wakes a bit dazzled and shakey but my mind obviously is on overdrive.

Tbh this doesn't sound like the classic onset of type 1 in a young child. Adults may display different symptoms, but children typically start to show symptoms of thirst and polyuria (always needing the toilet or wetting when previously dry), and go downhill rapidly over a matter of days. Hopefully your GP is looking at other possible reasons for your son's symptoms, but it wouldn't take him a minute to just rule out type 1 with a fingerprick, and put your mind at rest. X

 

[Diabeticliberty]

If you buy a finger prick meter first thing tomorrow you can ring your GP with the result by 9.15am this does give your little one a 24 hour head start if it is in fact type 1 diabetes

 

[Nict]

Thank you. I appreciate your comments/replies. She has ordered other blood work too.

 

[DeusXM]

She thought he was a bit young to show symptoms!

Oh, for heaven's sake....

...your GP needs to be fired and sent back to medical school until they stop being incompetent and unfit to practise. Hasn't she ever heard of T1 diabetes?