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Question:

From Bristol, England:

My toddler daughter has had issues with reflux and with what we think is milk. Our useless general practitioner dismissed our concerns despite very real symptoms and issues with her, only doing one RAST (radioallergosorbent test) (allergy rather than intolerance) test in the one and a half years we've been pushing to get to the bottom of that issue. We've just gone private and found that she does have a food intolerance but, as yet, don't know to what at this point. Apart from that, she seemed perfectly okay until approximately six weeks ago. She suddenly started drinking a lot, 70 to 90 ounces per day and wetting through her nighttime nappy. She always was a soaker but it is now at the point where we put her to bed at 6 p.m., change her at 10 p.m. and by morning, 6 a.m., she's soaking again. She is regularly soaking in the daytime also. She sweats terribly during the night, even in the cooler months and with limited bed clothes on. Her hair is often plastered to her forehead when we go in and check. We also noted she was waking up each night, sometimes two or three times, crying out. Her hands were jittery and she appeared not to be quite orientated with her surroundings. She was also asking for drink each time, too.

She has also got a nappy-type rash that she had a problem with on and off since she was about one and a half-years-old (connected to her intolerance issue) but, back then, it always cleared up after a dose of Sudocrem overnight but, this time, it's been ongoing. The skin isn't broken, just very red, like nappy rash, but also there are a couple of spots under the skin in that area that just won't shift whilst the redness varies from every other day or so, never going away completely. My daughter has a very pale complexion and dark, almost mauve, rings around her eyes. She is not tired though at all; in fact, she's dropped her afternoon nap. We had her weighed at the request of her general practitioner (regarding the intolerance issue) and she has dropped slightly on the centile chart. She used to be on the upper end of the chart, but had dropped. The HV (health visitor), who had no idea about her intolerance stuff alone, said it wasn't a concerning issue but, coupled with these new symptoms, I am starting to wonder if there were a connection. We had her weighed again a month later and she had slightly dropped yet again despite a healthy appetite. Lastly, we've noticed a couple of times that she will stare into space, with no reaction, and then suddenly just drop off into a nap of sorts. So far, this has only been noted in the car so we are unsure if she was just zoning out because of the motion and the warmth and such. We've also noticed she is very temperamental these days although, of course, that could just be the age she is, terrible twos!

As my husband has type 2 and my grandmother had type 1, of course diabetes was our first guess. I tested her a few times and am not convinced that the results indicate diabetes. We used the Accu-Chek Compact Plus. Each barrel of test strips has been calibrated with the control solution for accuracy. We also either wash her hands with antibacterial soap or use a medically certified wipe. For your information, her results have been: fasting - 4.9 mmol/L [88 mg/dl]; 4.1 mmol/L [74 mg/dl]; 5.2 mmol/L [94 mg/dl]; about one hour after lunch - 6.1 mmol/L [110 mg/dl]; 90 minutes after lunch - 6.3 mmol/L [114 mg/dl]; and one pre-meal reading of 7.1 mmol/L [128 mg/dl]. All these tests were done randomly as such, not every day or even on the same day in the case of the fast and then lunch.

One night she was jittery and crying out and wouldn't settle, I didn't get the meter but gave her some milk and her blood sugar was 5.4 mmol/L [97 mg/dl] 15 minutes after that. She hadn't had anything for four and a half hours or so before that event.

As you can see, there has been nothing at all indicative of diabetes on that front. I hear that the fasting blood sugar is the biggest indicator, but she's nowhere near showing diabetes on random testing or fasting either. Would it really be worth asking for a GTT or is it unlikely to show anything that the finger testing wouldn't have already picked up?

I don't want to test her any further since it's not showing anything worrying or obvious from the blood sugar point of view but she has classic symptoms without any blood work signs so I'm holding off for now and just seeing what else might happen. Knowing how much we've struggled to get help with my daughter's health already, I am reserved about wanting to go back with these new concerns. Don't get me wrong, that's not to say I won't or I'd ever let her suffer for fear of being labeled a neurotic parent but, yes, I wanted some advice and opinions first please!

I'm thinking "some" of these symptoms point to diabetes insipidus, which is not connected to the diabetes as we know it on this site. What is your opinion?

Answer:

All you describe is definitely not normal so I would agree that this all needs to be checked, too. The blood glucose readings you have done are not elevated so it is unlikely that this is diabetes mellitus. She needs a urine sample for urinalysis to check things like specific gravity, anything else abnormal in the urine and she may also need a vaginal or urine culture. I would suggest your returning to the pediatrician to get this checked out. It does not sound like she needs formal glucose tolerance testing but other laboratory work, electrolytes, kidney functions, thyroid functions and adrenal functions may need to be checked as well. It is not normal to lose weight. Other gastrointestinal problems would not likely cause excess thirst and urination like you describe but weight loss demand more investigation as well: celiac disease, inflammatory bowel disorders, eosinophilic esophagitis, reflux, etc. Seeing a pediatric gastroenterologist also may be helpful as may seeing a pediatric allergist.

SB

DTQ-20090129140559
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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