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Question:

From Catlett, Virginia, USA:

My six year old son had sugar in his urine on two different occasions following a routine check up in the doctor's office. Because of our family history, his doctor said to periodically check his blood sugars and report any highs or symptoms. That was four months ago.

Then, one day, my son began requesting drink after drink so we just tested his blood sugar and he was 231 mg/dl [12.8 mmol/L]. We checked it throughout that evening and, finally, at bedtime, he returned to a normal level of 86 mg/dl [4.8 mmol/L]. I spoke with our doctor and he said if it went above 120 mg/dl [6.7 mmol/L] to call him back, above 200 mg/dl [1'1.1 mmol/L], go to the Emergency Room (ER).

The next morning, he was 76 mg/dl [4.2 mmol/L] prior to breakfast. One hour post-prandial, he was 276 mg/dl [15.3 mmol/L]. Ninety minutes post-prandial, he was 353 mg/dl [19.6 mmol/L], so off to the ER. When we arrived there, he was hypoglycemic (we live a few hours from the hospital). At the hospital, they gave him a four ounce container of juice and 20 minutes later, his blood sugar was 121 mg/dl [6.7 mmol/L]. Within an hour, they checked his laboratory results and he was 47 mg/dl [2.6 mmol/L]. They sent us home and told us to follow up with an endocrinologist.

After several attempts to get in to one, our doctor spoke to an endocrinologist who requested we do fasting and two hour post-prandial readings prior to making an appointment. We did. His fasting blood sugar was 47 mg/dl [2.6 mmol/L] and his post-prandial reading was 305 mg/dl [16.9 mmol/L]. He was admitted to the hospital with a diagnosis of early onset type 1 diabetes. After a horrible experience in the hospital, where his sugars were checked way off schedule, we were sent home and told just to monitor his sugars and placed him on a low carbohydrate diet. We were to report to them only if he had two blood glucoses over 200 mg/dl [11.1 mmol/L].

I called them to tell him he was 247 mg/dl [13.7 mmol/L] and then 218 mg/dl [12.1 mmol/L] yesterday and they informed me that he is what they call "glucose intolerant" and not diabetic because he does not have the antibodies. They also said that, until his morning levels go above 150 mg/dl [8.3 mmol/L], there is nothing they can do for him. His morning pre-breakfast numbers range from 47 to 89 mg/dl [2.6 to 4.9 mmol/L]. My concern is these highs and lows and how they are affecting his body. Is there anything that can be done? We have an appointment with another endocrinologist, but it is several months before we can get in. I should also mention my son has speech apraxia and is developmentally delayed, therefore, he cannot tell us when he has highs or lows. Any suggestions or information would be helpful.

Answer:

The blood sugar numbers you report are not normal. He certainly has glucose intolerance but does not meet strict criteria for diabetes since fasting blood glucose levels are normal. It is likely that this is an early phase of type 1 diabetes. Antibody tests can be negative about 20 to 40% of the time so they are only helpful to confirm the diagnosis of type 1 autoimmune diabetes mellitus but not to exclude it.

Did they give you some dietary advice to avoid simple sugars or a meal plan to follow? Did they give you advice about continuing to monitor his blood sugar levels?

You should stay in close contact with the diabetes team with whom you are working until you can get a second opinion from another pediatric diabetology team. Any weight loss or increasing blood sugar levels should mean getting back in touch with them right away. Similarly, if there are positive blood or urine ketones associated with the high blood sugar readings.

SB

DTQ-20050613110208
Original posting 26 Jun 2005
Posted to Diagnosis and Symptoms and Other

  
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Last Updated: Tuesday April 06, 2010 15:10:02
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