Unusual Case of Potential Diabetes in a Teenager
I find myself in quite a perplexing scenario. As a registered nurse in the intensive care unit, I'm mostly accustomed to treating adult patients, but occasionally, we see 16-year-olds, giving me just a smidgen of experience in that area. A family friend has a 15-year-old transgender boy, standing at 5 feet 3 inches and weighing 95 pounds. He has a history of disordered eating. Recently, he has been grappling with several concerning symptoms: significant thirst, frequent urination, and unusual episodes of falling asleep in class or during the day on weekends—even though he seems to get enough rest at night. Additionally, he’s struggling to concentrate, wears corrective lenses, and has reported worsening blurry vision. Over the last year, he has lost at least 10 pounds. Given these signs, a diabetes evaluation was clearly warranted. However, all the laboratory tests returned normal results, including a fasting glucose level of 84 and a creatinine level of 0.87; both are well within the expected range. The comprehensive metabolic panel (CMP) and complete blood count (CBC) also showed no irregularities. Yet, the hemoglobin A1C surprisingly came back at 6.9. The family friend is concerned that this A1C result might be erroneous and is hesitant about seeking a referral to an endocrinologist. They believe that the child can safely wait for his routine check-up with the primary care physician scheduled for July. Is my concern about this situation warranted? I've always placed more confidence in A1C readings than a single fasting glucose test. In my past experiences with newly diagnosed diabetes, A1C levels were typically much higher, or patients often had obesity as a factor. Thyroid function tests were also conducted and came back normal.
Answers (1)
3/22/2025, 11:30:35 PM
OpenHealth AI
It's understandable to be concerned given the combination of symptoms and the A1C result of 6.9, especially in a teenager with a history of disordered eating. This level suggests the possibility of prediabetes or even diabetes, particularly in the context of his other symptoms, such as excessive thirst, frequent urination, and blurred vision.
Explanation
A hemoglobin A1C of 6.9 indicates that over the past 2-3 months, his blood sugar levels have averaged above the normal range. While fasting glucose levels can sometimes provide reassurance, the A1C is considered a more reliable indicator for diagnosing diabetes. The symptoms you're observing, along with the A1C result, warrant further evaluation, even if the other lab tests are normal.
Next Steps
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Encourage Immediate Support: Discuss the situation with the family friend and express the importance of not delaying further evaluation. Given his symptoms and the A1C result, waiting until July may not be advisable.
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Monitor Symptoms Closely: Keep track of any changes in symptoms such as thirst, urination, energy levels, and concentration. Note if other symptoms develop, like increased hunger or unusual fatigue.
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Maintain Healthy Habits: Encourage healthy eating and hydration. If possible, collaborate with the family to promote balanced meals and appropriate activity levels, which can help manage any potential blood sugar issues.
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Referral to an Endocrinologist: Strongly recommend that the family consider accepting a referral to an endocrinologist. An expert can provide deeper insights into diagnosis and management, and they can offer tailored advice specific to his unique situation as a transgender teen.
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Education on Blood Sugar Management: Provide information about blood sugar management. Even if the initial tests are normal, understanding the signs of high and low blood sugar can be helpful.
Your vigilance as a nurse is commendable, and addressing this potential issue early could lead to better long-term outcomes. Supporting and guiding the family to seek further evaluation is critical in this situation.
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