<s>[INST] I have diabetes. My 4 yr old grand daughter is always after me to stick her finger and I playingly do so. She has Down Syndrome and so tonight I finally gave in and did a stick and her sugar was 204. Is that normal to be so high? Thats more than mine on most occasions. [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Children with Down syndrome are at a considerably increased risk of diabetes. It can be type 1 Diabetes and generally it is coexistent with other autoimmune diseases but even Type 2 diabetes may also present at an early age in Down syndrome due to obesity and insulin resistance. From your description, I can deduct that the measurement was a random blood sugar result. Random blood sugar test is the primary screening test for type 1 diabetes. A blood sample is taken at a random time. Regardless of when the child last ate, a random blood sugar level of 200mg/dL or higher suggests diabetes. So,to resume:204 mg/dL is not normal. It's higher than the normal  blood sugar level and it is suggestive for the diagnosis of Diabetes Mellitus. In these circumstances,my advice it to do a fasting blood sugar level and HbA1C test. These test are important to clarifies the situation. A fasting blood sugar level of 126 mg/dL or higher and an A1C level of 6.5 percent or higher on two separate tests indicates  Diabetes. Fasting blood sugar test. A blood sample is taken after your child fasts overnight. Hope I have answered your query. Let me know if I can assist you further. </s>