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Question:

From New York, USA:

Please help! I have a 7 year old son that was just released from the hospital after a week-long fever and admitted with a blood sugar of 42 and discharged with a value of 218. This happens every 2-3 months. They do not classify him as diabetic. His lowest blood sugar was 22 and highest 397. His daily blood sugars are erratic and am having a hard time trying to get a normal balance with diet. His ped doctors say they have never seen a child do this or heard of one. This is no help. Is this harmful in the long run on his organs?

He had Kawasaki disease at 18 months and hasn't been right since. Has colitis, joint pain, fevers, just diagnosed with Von Willibrands. Is there any medication that can be given to a so-called nondiabetic child to regulate his sugar. These episodes wipe him out. Are there any centers that do research in hard to figure out cases that i could contact? He was taken to a major hospital in New York City and they observed all that goes on with him but could not explain it other than insulin deficiency and something about the cells not working right. He did the fasting 6 hour glucose tolerance test and his readings started in 178 and slowly started to drop then shot up to 197 towards the end. The doctors at the hospital said the readings were unusual but still only classified him as hypoglycemic. Any input would be appreciated.

Answer:

This sounds like an extremely complex problem and not one that can be much resolved without seeing your son and meticulously reviewing all the tests that have been done. You say that your son did spend some time in a New York Hospital and I wonder if this was in a Clinical Research Center supported by the National Institutes of Health. If not, you might talk to your pediatrician again about seeing if there is an accessible one to which he can be admitted under the care of a pediatrician with a special expertise in metabolic problems. This will not be easy to arrange and you may have to push fairly hard to convince the present medical team that it would help.

Type 1A (autoimmune) diabetes may present with hypoglycemia although that is quite rare in your son's age group. But if he indeed had low levels of insulin that is possible and a way to confirm this would be to have an antibody test done; the number to call for more information is 1-800-425-8361. If this test is positive it would suggest that your son might have a rather unusual form of what is called Autoimmune Polyglandular Syndromes. What this is is a grouping of several disorders of the immune syndrome of which Type 1A diabetes is one. This might explain his joint pains and his colitis and even his Kawasaki syndrome; but would not explain the Von Willibrands's Syndrome if a specific depletion of Von Willibrand factor in the blood has been proved. Confirmation of an autoimmune problem could then suggest specific treatment including very small doses of insulin even at this stage.

If this test is negative then It seems to me that the next stage is to decide how to manage the hypoglycemia. Since your son has not apparently had any evidence of central nervous system involvement with his episodes of hypoglycemia, it might be worth starting to keep a record of blood sugars around the clock rather like a diabetic has to do in order to find out when he is most vulnerable to hypoglycemia and whether the episodes are in any way related to calorie intake; e.g. only when he has a fever and whether they are accompanied by ketones in the urine. This information may suggest simple treatment with timely dietary supplementation. There may come a point however when it becomes advisable to embark on a complex metabolic investigation of the cause of the hypoglycemia and this will require expert laboratory skills.

The issue of the possible harmful effects of the hypoglycemia must be of concern. For the most part if there are no symptoms of the hypoglycemia it is often safe to assume that his system has available other means of supplying the brain with energy. Certainly there have been incidences where repeated low blood sugars have not affected cerebral function; but at the same time it is not known that this is always the case so that, within reason it is important to treat the low blood sugars effectively.

I am sorry if this seems a very brief and inadequate response to what sounds like a worrisome and difficult problem. I hope you eventually get to the explanation.

DOB

Additional comments from Dr. Quick:

The situation described by the writer of this question is certainly not a typical problem faced by the average parent of a child with diabetes. Instead, it is clearly an extremely complicated and almost unbelievable combination of diagnostic dilemnas that will take a full-court press by a team of pediatric specialists to unravel, and adequately address.

We have chosen to publish this question, and Dr. O'Brien's thoughtful response, to demonstrate to our readers the line of reasoning that pediatric experts use to attempt to dissect very unusual and complex medical cases.

WWQ

Original posting 22 Apr 1999
Posted to Other Illnesses

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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