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Question:

From Loganville, Pennsylvania, USA:

For seven months, my 18-month-old daughter has been waking up shaking and crying. I usually give her straight juice and her breakfast. My mother is diabetic and so was my great-grandmother and on my father's side of the family, my grandfather is diabetic. To make it worse, my daughter's father's uncle and grandmother have/had diabetes. When my mom saw my daughter's symptoms, she suggested my daughter be checked for diabetes. When we checked her sugar, using my mom's meter, my daughter was 55 mg/dl [3.1 mmol/L]; I checked again and she was 56 mg/dl [3.1 mmol/L]. I called her doctor took her in for an appointment and the doctor was very rude! He shrugged off my daughter's symptoms so I grabbed my daughter and left.

On July 4, my daughter would not wake up. At 11:00 a.m., I woke her up. She flipped out something horrible, screaming and crying and wanting to lie back down. She was shaking horribly! She had that fruity smell to her so I checked her sugar and it was 40 mg/dl [2.2 mmol/L]. I fed her pancakes with syrup and actually gave her sweet tea. About three hours later, we checked her sugar and it was 276 mg/dl [15.3 mmol/L], and the meter said KETONES?

I got my daughter another appointment with a different doctor who ordered blood work. The doctor said everything looked good. Her A1c was 5.5. I asked for her blood results and I was looking them up online to match them with normals. Her TSH was 2.99, which meant her thyroid was not functioning, according to the Internet. So, now I'm confused and worried. My daughter cannot tell me how she feels. I do notice she drinks a lot and is always hungry. Since I have a glucose meter and can check her sugars, I have seen that she will be in the 200s mg/dl [over 11.1 mmol/L] all the time. Is it normal for a non-diabetic to have sugars like that even three hours after eating? We've had an episode when we were driving and we could not get her to wake up. My fiance had to squirt juice in her mouth, then, days later she was really fussy and fell to her side and crying but her sugars were almost 300 mg/dl [16.7 mmol/L]. I'm so confused and lost.

Answer:

The easy part first. The TSH of 2.99 is normal so she does not have any thyroid problems at the moment. Most normal TSH levels are up to about 4.5 to 5.0.

As far as diabetes, it is definitely not normal to have even occasional blood glucose levels in the 200s mg/dl [over 11.1 mmol/L] or 300s mg/dl [over 16.7 mmol/L] ever. But, it mostly sounds like she has hypoglycemia and that explains the symptoms you describe with blood glucose levels at the same time in the 40s mg/dl [2.2 to 2.7 mmol/L] and 50s mg/dl [2.8 to 3.2 mmol/L]. This could just be hypoglycemia from her body making too much insulin or could be a precursor to her developing diabetes where the pancreas stops making insulin and thus the high sugar levels. Sometimes, before diabetes actually shows up, the pancreas gets "confused" and does a bit of both. Either way, the best treatment is to make sure that she eats protein/fat continuing food/snacks every three hours and limits simple sugars (candy, juices). This way the body does not need so much insulin and does not have to underproduce or overproduce. If she acts this way again and you document blood glucose below 60 mg/dl [3.3 mmol/L], then treatment is juice, glucose tablets or glucose gels. Most pharmacies have them in the diabetes section. But, most importantly, you should schedule an appointment with a pediatric endocrinologist who can order more detailed tests, antibodies, insulin levels, etc. and help you decide how to monitor your child, when to call for assistance, etc.

Sorry that you did not get the help you needed from your primary health care providers.

SB

[Editor's comment: See also a related question. BH]

DTQ-20090727114119
Original posting 3 Aug 2009
Posted to Diagnosis and Symptoms and Hypoglycemia

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