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Question:

From Burlington, Washington, USA:

My 10-year-old daughter has had type 1 for three years. We also have a 17-year-old who has had type 1 for seven years. My mother-in-law died from renal and heart complications after 40 years with type 1. Tonight, our younger daughter came downstairs when called for her turn to bathe and told us she needed to eat first. She asked her older sister to open a can of juice for her and then the 10-year-old free fell to the kitchen floor, unconscious. We were able to rouse her and she drank two juices (I had the glucagon ready, too). She was cold, pale, shaky and sweaty. Her glucose level was 165 mg/dl [9.2 mmol/L] about two minutes after she came to. We retested because that seemed high for the situation and she tested at 135 mg/dl [7.5 mmol/L], four minutes after coming to, after drinking the juices. We called the endocrinologist on call at Children's (Seattle) and asked if it might have occurred because she had been running high, that a "normal" blood glucose acted like a low. He said that it was impossible to tell and that it could have possibly been a non-blood glucose issue. He confirmed that she was doing okay and that was it.

Last month, my 10-year-old had an A1c of 7.8 and she has been running in the 200 mg/dl [11.1 mmol/L] to 300 mg/dl [16.7 mmol/L] range the last week or so. We speculated about feeling low with normal after running high because my husband recalled from growing up that this had happened to my mother-in-law periodically. I am wondering how likely is it that this is the case. I feel I have to operate on "most likely cause" since the endocrinologist says we can't tell for sure. Since this was her first severe loss of consciousness, we will definitely follow-up with the school nurse (to let her know to watch for "low" behavior even with a normal blood sugar) and I will be calling our diabetes educator too to work on how to get her numbers normal, but not so quickly that this happens again. So, the question is: Is an apparently "normal" blood sugar possibly a "low" to the point of loss of consciousness if you have been running high? Does this sound like a reasonable guess for this situation given that the endocrinologist already stated that we won't know for sure?

Answer:

It does not sound like hypoglycemia and high sugars cannot cause such a severe neurologic abnormality. I would worry about a seizure disorder and check an electroencephalogram, MRI, etc. to look for a treatable cause. I do not believe that chronic hyperglycemia can cause such problems without another explanation. In adults, one must worry about heart, stroke, blood pressure and other problems with thyroid and adrenal system as well as liver; in children, these are much less likely but she needs a detailed examination and laboratory work to be sure.

SB

DTQ-20070122004900
Original posting 24 Jan 2007
Posted to Other

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