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Question:

From Gold Coast, Queensland, Australia:

My three-year-old daughter has recently been displaying classic diabetes symptoms, weight loss, increased urination, fruity breath (intermittent) along with a greatly increased appetite and wild mood fluctuations. She gets occasional upper right abdominal pain and general aches in her limbs. She goes from crazy hyperactive to very irritable to weepy, pale and tired in the space of an hour or so. She has not had the extreme thirst I read about, but she has been asking for a drink on occasion, which is very unusual for her. I usually have to use some sort of leverage to get her to drink, e.g., no t.v. unless she has a glass of water. These symptoms were ongoing for about two weeks when I decided to get her to a doctor. She lost about 1.5 kgs (3 pounds) in that time. She weighed 15 kg (22.5 pounds) before she lost weight. The symptoms had eased slightly over the weekend while we waited for the appointment. The urination has since eased to almost normal levels, but she is still moody and very hungry, more than twice her usual food, but only managing to maintain or slightly drop weight.

The doctor suspected diabetes and did a dip stick test in her urine, which was all clear, but it was sent to pathology along with blood tests. At the time of the test, she was very low, sitting on the chair next to me with her head on my lap, asking to go home to bed.

Her non-fasting blood glucose came back as 4.4 mmol/L [79 mg/dl]. Her platelets where elevated and most other values (no antibodies or insulin tested for) were in the normal range or only slightly outside so the doctor said that it wasn't diabetes. Could it still be? She has been unwell on and off over the last 12 months, but these particular symptoms have only recently started. He gave me a referral to a paediatrician, and I am hoping that they investigate it further because her moods are definitely influenced by what she is eating. Getting her to eat makes her more "normal" for a while, before the roller coaster starts all over again. How fast does the "honeymoon" kick in and can it give these sorts of blood results? The day she had the test was the day the symptoms eased. Was the doctor too hasty in eliminating diabetes when the symptoms are so similar? Is it possible to confirm or eliminate diabetes during the honeymoon period?

Answer:

The elevated platelets is very non-specific ranging from mild dehydration to an inflammatory response, which itself could run the gamut of mild to serious.

Based on the information, this does not sound like diabetes mellitus right now, especially in light of normal blood and urine glucose. What could it be? The possibilities themselves are long. Could the laboratory have made a mistake? Yes, but probably not for BOTH the blood and urine glucose values. Could the child have an early phase of diabetes and you screened "at just the wrong time?" I supposed so.

I strongly agree that your little girl be examined by a pediatrician. Some further or repeat general screening tests of common blood chemistries and other markers of inflammation may well be in order. There would be NO REASON for your family doctor or the laboratory to have done pancreatic antibodies or insulin values at this time in light of normal glucose readings.

The diabetes "honeymoon" per se does not manifest until AFTER insulin therapy is started in a patient with newly established, confirmed type 1 diabetes. The honeymoon commonly manifests within the first six weeks of diagnosis and the initiation of supplemental insulin.

Good luck and let us know what you find.

DS

[Editor's comment: You may also wish to discuss the possibility of Ketotic Hypoglycemia with the pediatrician."Fruity" breath is often present when one is producing ketones. BH]

DTQ-20081007093051
Original posting 20 Oct 2008
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:10:16
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