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Question:

From Pittsburgh, Pennsylvania, USA:

My son has been showing some signs of diabetes. I first noticed that his breath smelled sweet and someone told me that this was a sign of diabetes. I looked into it and found that there were other symptoms. About a month ago, he started urinating through his pull-ups at night. Previously, he had either been dry or just slightly wet in the morning. He has constant access to water at home, but he has started to ask (or scream) for a drink any time we are out. Often, he says that he feels better after he gets a drink. He has also complained that his eyes hurt. A little over a year ago, he was diagnosed with PDD-NOS so he has limited communication skills, making it difficult to determine if it were due to blurry vision, but it also started recently. Finally, everyone involved with him has noticed behavior changes in the past few weeks that cannot be attributed to changes in routines or other typical triggers for him. He has a limited diet that consists mostly of foods high in carbohydrates. We have been working with our autism team to get him to accept more foods, but it is a slow process.

My older sister and my father have type 2 diabetes, so we used my sister's meter to check my son's glucose levels. The first test was half an hour after having icing from one of his birthday cupcakes. His blood sugar was 179 mg/dl [9.9 mmol/L]. Later that evening we had a reading that was 109 mg/dl [6.1 mmol/L], 90 minutes after eating chicken nuggets. The next morning, I checked his blood sugar as soon as he woke up and it was 176 mg/dl [9.8 mmol/L]. This morning, it was only 76 mg/dl [4.2 mmol/L]. After the reading yesterday, I thought I would be calling the doctor today but, now, I don't know what to do. I plan to test him again in the morning. I noticed today that the sweet smell was less intense than it was over the weekend. Should I check him at other times? Is the doctor likely to think that I am overreacting? He has a yearly exam scheduled, but it is not for another month.

Answer:

Sorry, but this is definitely abnormal. Pre-food normal blood glucose is generally the 60 mg/dl [3.3 mmol/L] to 99 mg/dl [5.5 mmol/L] range and post-meal values shouldn't exceed 126 mg/dl [7.0 mmol/L] to 140 mg/dl [7.8 mmol/L]. So, you should discuss this with your pediatrician or family doctor and then make arrangements to get consultation with a pediatric diabetes specialist. In the meantime, give plenty of sugar-free liquids, water, etc., so that he does not get dehydrated. Watch his weight daily. If weight loss occurs, you may want to go to the Emergency Room for an instant evaluation. Also, it would be reasonable to avoid most simple sugars and carbohydrates since these all would tend to raise the blood glucose levels. The high fat chicken did not do this since there is not much insulin needed for such foods. Lastly, it would also be reasonable to continue to monitor blood glucose levels before and one to two hours after meals so that you know if things stay the same, get better or worse. Blood sugar values moving upwards would also need urgent evaluation by a diabetes specialist as well. Some medications that are used for PDD may cause some hyperglycemia but this needs to be reviewed with the diabetologists.

SB

DTQ-20090126180209
Original posting 2 Feb 2009
Posted to Diagnosis and Symptoms

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