From Massachusetts, USA:
My daughter, age 3 years and 11 months, is being worked up for diabetes. She is adopted, therefore we have no family history information. She is of Eurasian descent.
She has had a sinus infection on-off for 2 months, recently having an ear infection and is on 20-day antibiotic therapy. She had a febrile illness, diagnosed as probable flu, with temps 103-105 in the midst of this week.
Her doctor checked her urine as routine and found 2+ sugar and 1+ ketones. A lab serum level 1 hour later showed a blood sugar of 114 and negative for ketones. Her glycohemoglobin was 6.3% with the range normal high of 5.9%. Her urine for the past 2 days has been negative for glucose and trace for ketones. She always has a phenomenal appetite, eats everything healthy, and drinks well. Weight 38 1/4 lbs. Her appetite and thirst have been slightly diminished with this illness. The other night with an elevated temperature, she wet her bed twice (the first time of any bed wetting in 8-9 months.) We have a scheduled appointment for a glucose tolerance test in 5 days.
I am no doubt anxious and concerned. What are your thoughts about this situation? I can only wait but would benefit from info. I hear much about prediabetic conditions. Would she be a candidate for "antibody" or other such testing to see if she will develop Type 1 diabetes? And, to save her from trauma during the glucose tolerance test, can finger stick measurements be done of her glucose versus. serum levels (drawing serum if the fingerstick is too high)?
We know that the pancreas is slowly failing for months or years before the blood sugar becomes abnormal in children who develop insulin dependent diabetes. Whenever anyone (diabetic or non-diabetic) has an infection, he needs to make more insulin to keep the blood sugar normal. If your child's pancreas is failing, it may be able to make enough insulin to keep the blood sugar normal when she is not sick, but may not be able to make extra insulin to keep the blood sugar normal during illness. Thus, it is possible that intermittently high blood sugars may occur during illness before the blood sugar becomes permanently abnormal. The slight elevation of hemoglobin A1C (if done in a reliable lab) is suggestive that your daughter may have other undiagnosed episodes of high blood sugars and may be developing diabetes.
On the other hand, occasionally children may temporarily develop a mildly elevated blood sugar during an illness. Studies have shown that only 25% of these children go on to develop permanently abnormal blood sugars (diabetes) if this only happens once and lasts a short time.
If antibody testing is done, and is abnormal, it would be very likely that your child is in the process of developing diabetes.
There are pros and cons of doing a glucose tolerance test at this time which you must discuss with your own physician. I usually do suggest that at the least, you test your child's urine for sugar, especially when she is sick and the blood sugar is most likely to be elevated. Confirming that the blood sugar is elevated when there is sugar in the urine is important, as some children spill sugar in the urine when the blood sugar is normal (renal glycosuria). A home meter is useful if the blood sugar is over 200 and you are using it accurately, but is not accurate enough to distinguish a normal blood sugar from a minimally elevated blood sugar.
By the way, over 90% of children who develop diabetes and who know their relatives do not have a family history of diabetes, so don't worry that you don't know if any biological relatives had diabetes.
Good luck, and be sure to stay in close contact with your daughter's physician.
Original posting 9 Dec 96
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Last Updated: Tuesday April 06, 2010 15:08:52
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