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Question:

From Ft. Lauderdale, Florida, USA:

My six-year-old daughter was diagnosed with type 1 diabetes about a year ago. She is 114 cm (44.9 inches) tall and weighs 48 pounds. Previously a healthy child, she came down with pneumonia and was given many different prescriptions: steroids (inhaled and oral) and antibiotics. The antibiotics were changed at least three times. She was consistently febrile, her lungs were "congested," and she was very lethargic. After nearly four weeks, she was hospitalized with pneumonia. While there, she had elevated blood sugars. The pediatrician said it could have been the infection and, although the oral steroids had been discontinued, possibly that as well. She was treated with I.V. antibiotics for three days. She improved immediately and was discharged. The pediatrician was checking her blood sugar every few days and found them to consistently high so, we were referred to an endocrinologist. The endocrinologist ran a complete profile and the laboratory results came back as follows: glycohemoglobin 5.8; rbc morphology - normal; cbc - all normal -- (slightly out of range wbc 4.9, lymphocyte 60.0); phosphorous - 4.8; magnesium - 2.2; lipids - normal; liver function - total protein - 7.8; albumin - 4.8; alkaline phosphatase - 123; sgpt (serum glutamic pyruvic transaminase) - 4; sgot (serum glutamic oxaloacetic transaminase) - 57; dir bili (direct bilirubin) - 0; total bilirubin - 1.4; calc osmo - 271; blood ketones - negative; UA (urinalysis) - trace ketones; TSH - 0.96; T-4 - 10.9; C-Peptide (not fasting) 3.0; Human insulin antibody - 31; Anti GAD - 19; ICA 512 - 12; insulin (not fasting) - 14.

She was admitted for diabetes and we went through the usual inpatient teaching. She went home on one unit of Levemir and Humalog to cover her blood sugars over 250 mg/dl [13.9 mmol/L]. This past summer, we discontinued the insulin due to lows and we are just covering the highs. She wakes up with a blood sugar of 95 mg/dl [5.3 mmol/L] to 115 mg/dl [6.4 mmol/L]. Before meals, she is never higher than 180 mg/dl [10.0 mmol/L]. So, I wonder sometimes if this were diabetes because she corrects without insulin. Also, without insulin she goes low, in the 50 mg/dl [2.8 mmol/L] to 60 mg/dl [3.3 mmol/L] range. Some days, she has completely normal numbers; others, she is very erratic. The endocrinologist says it is diabetes because of the presence of the three antibodies and that we are just very early in the autoimmune process.

Can you give me your thoughts? Do you think that this is truly diabetes? If diabetes, how far along in the process is she? Is it common to have patients with this type of irregular and sometimes normal sugar levels?

Answer:

I am afraid that I would agree with your endocrinologist. The antibody levels could be repeated to see if they persist, increase or decrease. The blood glucose levels you are seeing sound normal pre meals (i.e., <100 mg/dl [5.6 mmol/L]), but the postprandial values are, at least sometimes, too high if they reach 180 mg/dl [10.0 mmol/L]. Normally, they should not go much above 126 mg/dl [7.0 mmol/L] to 140 mg/dl [7.8 mmol/L] range. So, there is some early degree of insulin deficiency and the pancreatic thermostat is not always working well. Whether or not to treat with insulin is more difficult since this wold depend on a lot of blood glucose determinations to see how often normal and how often abnormal. Sometimes, with such early pancreatic illness, the beta cells can also over-respond and thus cause the intermittent hypoglycemia. The best advice is usually to follow a strict diabetes meal plan that avoids simple sugars since this allows the pancreas beta cells to rest and hopefully last longer. There is some evidence that being strict in this phase with food helps prevent further damage to the beta cells and prolongs this relatively stable phase.

SB

DTQ-20081009210348
Original posting 22 Nov 2008
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:10:18
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