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Low insulin level, normal glucose level



My daughter is 8 she weighs 55 lbs and is four feet four inches tall. Recently my husband was diagnosed with diabetes. She was curious about the meter and asked me if I would check her sugar. So I did. Her sugar seemed a little high, so I have been keeping an eye on it. I called the dr. and they had her go for a fasting insulin and glucose test. The results came back that her fasting glucose was 80 which was very close to what my meter read that morning, and that her insulin level was slightly lower at 5.6. I have noticed through testing her that her fasting sugars do tend to be normal are just slightly above, but some of her post meals are quite concerning, one the other night was 171 2 hours after eating. My question is what could be going on here, could her lower than normal insulin levels be high enough to keep fasting sugars normal but not enough to keep sugar normal durning the day after meals, and is this something that I should have the doctors look into further, because they seem to think this is all normal.


This can be a challenging situation:  You don't want to go looking for disease in a child if there is no reason to think it is going on - on the other hand, you want to be alert to any genetic predisposition there may be.  And you want to be responsive to the child's curiosity and help her feel that what is going on with her father is not foreign.  So some basics first:  We don't make diagnoses of diabetes on the basis of fingerstick glucoses; if there is really a reason to look, then it should be done with laboratory blood glucose testing.  Second, you don't say whether your husband developed type 1 or type 2 diabetes, what his age or weight are or what other family history there may be.  It is not always the case but people with type 2 diabetes tend to be overweight; Your daughter's height and weight suggest that she is petite.  There is another variation called maturity onset diabetes of the young (MODY) where there is early onset in multiple family members, they don't necessarily require insulin and they are generally not overweight.  I am not concerned about either the fasting blood glucose or insulin.  The 2 hr post meal sugar could also be quite reasonable and I don't think is reason for alarm.  Factors I would take into account in deciding whether to do periodic testing on your daughter include what the rest of the family history is like and whether her relative body weight is similar to or different from her father's and whether you are in a situation where it would make a difference, notably be near to a place where there is a study of preventing diabetes.  If she were to develop symptoms, that would change the decision-making considerably and evaluation would be warranted.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati