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Question:

From New York, USA:

My five year old son just recently has been experiencing polydipsia and polyuria, extreme fatigue, especially in the morning (at times he'll sleep in until 11 a.m.), grouchiness, moodiness, and weight loss (one pound in two weeks). His pediatrician ordered some bloodwork, fasting glucose, postprandial and basic metabolic panel. His fasting glucose was 65 mg/dl [3.6 mmol/L], while his postprandial blood sugar was 165 mg/dl [9.2 mmol/L] and everything was fine except for his CR (Creatinine) level was low (.4) on his metabolic panel. We bought a glucometer, an (Accu-Chek Advantage) and some days he'll be fine, anywhere from 70 to 110 mg/dl [3.9 to 6.1 mmol/L] while other days, he'll range from 139 mg/dl [7.7 mmol/L] to over 222 mg/dl [12.3 mmol/L]. My meter only reads to 222 mg/dl [12.3 mmol/L] and one evening he got HI which meant over the 222 mg/dl [12.3 mmol/L].

His pediatrician is thinking that he may have type 2 diabetes. It seems like his body is still producing some insulin because his fasting was low, but, as he eats, his body isn't producing enough to keep the levels within normal range. We find this especially true with his diet. On his good days, he'll have a pretty good diet; on his not so good days, his diet may be high in carbohydrates. She had also suggested that he may have what they call diabetes insipidus, which means he has the symptoms but it's related to the pituitary gland and not to the pancreas. From my understanding, this isn't true diabetes, that his sugar levels should be fine, that those who have diabetes insipidus just experience the extreme thirst and urination.

So, to me, he seems to have type 2. I'm waiting for her to fax a request to the laboratory so we can do a three hour Glucose Tolerance Test and an insulin level. This will hopefully give us a better understanding of what's going on. Is he just in the beginning stages of type 2? I've heard of the honeymoon phase that some experience in the beginning, but don't truly understand it. Is it for someone who's already on insulin or someone who's just newly diagnosed? Right now, he just has a pediatrician. Once his laboratory work is done and comes back, she's going to refer us to a pediatric endocrinologist. It just seems like the process is taking forever. My little guy is only 39 pounds at the age of five and just this past week we found that he lost a pound, so, now he's 38 pounds. This seems skinny for the usual with type 2, but it's predominant on my side of the family.

Answer:

I would urge you to see a pediatric endocrinologist now and not wait. This does not sound like diabetes insipidus since high sugar levels are not related to diabetes insipidus. However, his glucose levels are erratic and could mean a pancreas that is in the process of dying out and, thus, only intermittently able to make sufficient insulin for growth and metabolic needs. Rather than let him get sick, lose weight or become dehydrated, he needs closer endocrine monitoring. Perhaps also islet cell and GAD antibody levels should be done. If the antibody levels are negative, this will not help; if they are positive, this would indicate early stage of type 1 diabetes.

Also, I do not understand when you say your meter only reads up to 222 mg/dl [12.3 mmol/L] since meters read up to 500 to 600 mg/dl [27.8 to 33.3 mmol/L] range in the U.S. You should re-read the instruction manual and/or see a diabetes educator to review how you are doing the tests. You are correct that these are abnormal blood glucose values.

SB

DTQ-20050906094737
Original posting 14 Sep 2005
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:10:04
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