My daughter is five years old and was diagnosed with diabetes three months ago. She has always been very healthy and never shown any signs of illness apart from bed wetting and increased thirst. On admission to the hospital, her glucose levels were recorded as 12.6 mmol/L [227 mg/dl], which then dropped to 4.1 mmol/L [73 mg/dl] within one hour. Her fasting blood the next morning was normal, also. Her blood sugar levels varied greatly throughout her time in the hospital. During an oral glucose tolerance test, she was 15.1 mmol/L [272 mg/dl] after two hours, going down to 11 mmol/L [198 mg/dl] after three. This, I was told, was proof positive that she had type 1 diabetes. Her A1c was 8.5.
Since then, she was first placed on Lantus, but always woke very low, 1.6 mmol/L [29 mg/dl] to 3.0 mmol/L [54 mg/dl]. Then, she was put on NovoRapid, to be administered only if I found her above 10.1 mmol/L [182 mg/dl] before meals. This has only happened once in the past three months, until recently. I was told she is in the honeymoon period and would soon relapse to total insulin dependance. Within the past week, however, her glucose levels have gotten very erratic, ranging from 3.3 mmol/L [59 mg/dl] to 21.1 mmol/L [380 mg/dl]. When I have found her high before meals on two occasions, I have given her insulin. My doctor has now recommended that I stop giving insulin altogether until she is brought in for further tests. He says her readings are very unusual and different from other children and he would like to test for antibodies in her blood. He sounds unsure as to whether or not she even has diabetes anymore. How could she be getting these readings if she is not diabetic? Is it safe to let her blood sugars run high over the next two weeks? She has never had any ketones, however. She is not overweight and is steadily losing weight, becoming very skinny and gaunt looking. Her appetite, which was never great, has increased so much. In some ways she is so consistent with the symptoms of diabetes and in others she seems relatively normal. Also, is it possible for her to have type 2 diabetes even though she is so young and far from obese? With all the information I have taken in over the past few months, I no longer know what to think.
What you describe really is quite rare but can happen. It suggests a pancreas that is damaged and not responding normally. I assume that your doctor has done a thorough physical exam and also a laboratory exam looking for other explanations of intermittent hyperglycemia. I would agree that there needs to be more blood glucose testing pre- and post-meals to see if anything of a pattern is present. Islet cell and GAD-65 antibodies would be helpful only if positive, but they are not always positive, even with classical type 1 diabetes. If negative, they will not help. I would stay in close contact with your diabetes team so that they can give you advice on how to proceed, when to give insulin and how much. Time will help sort this out. The A1c suggests high sugars for many weeks/months.
Also, sometimes young children do better with Lantus in the morning instead of bedtime and some do better with Levemir instead of Lantus as basal insulin. Discuss this with your diabetes team and continue close surveillance with frequent glucose readings so that you can respond appropriately even with unpredictable up and down blood glucose levels.
Original posting 23 Oct 2007
Posted to Diagnosis and Symptoms
Last Updated: Tuesday April 06, 2010 15:10:14
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