Question:
My 3 year old daughter was diagnosed with Type 1 in November, 1995 (2 weeks
ago). She had pneumonia at the time and her blood sugar was 240, with high
ketones. Since she has recovered from the pneumonia, her blood sugar has
stabilized. Is this normal? Is this just a honeymoon? Could the high
blood sugar and ketones be explained by anything else?
Answer:
Kids who develop a severe illness such as pneumonia may have a transient
problem with high blood sugar due to the combination of dehydration and
inadequate food intake, and their blood sugar and ketone levels may be elevated.
In little kids with severe illnesses, the onset of Type 1 Diabetes usually
looks even more dramatic than seems the case for your daughter: the sugar is
frequently much higher than 240, and there's an increase in the blood acid
level (a condition that's called diabetic ketoacidosis or
DKA). We don't have enough information in your daughter's case to be
sure about the diagnosis: she'll need assistance from a pediatric
endocrinologist to be sure.
Does your daughter actually have Type 1 Diabetes? Assuming that the sugar
levels stayed consistently high after resolution of the acute
illness, the diagnosis of diabetes seems reasonable. Of course, several
weeks after the acute illness is gone, the blood sugar levels will probably
be much better, and indeed, making the diagnosis of diabetes now would be
nearly impossible based on the blood sugar levels now. More lab tests (for
islet cell antibodies and C-peptide levels) would be very
helpful to make the diagnosis.
If indeed she has Type 1 diabetes, you can expect continuing improvement in
blood sugar control in the near future, even on lower and lower doses of
insulin. This period of time where everything is going very well is called
the "honeymoon" period, and will last for a while, like any honeymoon, then
come to an end.
But if the diagnosis of diabetes can't really be established cleanly at this
time, we'd still be very concerned. We'd call the diagnosis "Impaired
Glucose Tolerance" and advise very close followup for the possibility of
developing diabetes later in life.
Original posting 14 Dec 95