From Fayetteville, North Carolina, USA:
My daughter is 2 years, 9 months old. She was recently referred to a pediatric endocrinologist because her regular doctor found sugar in her urine and also high blood sugar level at a recent sick visit. To keep this brief, the specialist ran several blood tests and had us monitor her blood sugar for several days. She had a few high readings, but the doctor said that all of the lab reports indicate that she does not have diabetes at this time. However, he did comment that he can not "foresee the future" and asked us to continue to check her fasting sugar level several times a week. Am I just reading too much into his comments or does this imply that my daughter may be at a higher risk for developing Type 1 diabetes because she is already experiencing periodic high sugar levels? When I asked the doctor about this he just repeated that he can't foresee the future. Do you think he was just trying to spare me unnecessary worry or is there cause for concern?
Increased glucose during a stress event does not lead to diabetes. Every study that has looked at this says that. Obviously the doctor doesn't want your child to develop diabetes just because she is at the same risk as the rest of the world and some will. The doctor could look for antibodies to islet cells, insulin, and GAD if they haven't already been done. These results might help clarify the situation.
Additional comments from Dr. Lebinger:Occasionally children do develop transient high blood sugars and sugar in the urine during an illness. About 75% of these children never go on to develop diabetes and about 25% of them do. We know that the pancreas is slowing failing before the blood sugar becomes elevated in children who develop diabetes. Normally the pancreas can make much more insulin than is necessary to keep the blood sugar normal. As it fails, it may make enough insulin to keep the blood sugar normal when the child is not sick, but may not be able to make enough insulin to keep the blood sugar normal when the child is sick (and temporarily requires more insulin). A special test for antibodies against islet cells can be done. This test is frequently abnormal when the pancreas is failing before the blood sugar is elevated. If positive, it would indicate that your child is very likely in the early stages of developing diabetes.
You might discuss with your child's pediatrician testing the blood sugar periodically after your child eats rather than just fasting. As the pancreas fails, the blood sugars 1-2 hours after eating may be abnormal before the fasting blood sugar is abnormal. The most important time to test (even more frequently) is if your child gets sick again. If your child is developing diabetes, her blood sugars could go very high very quickly during an illness requiring immediate treatment to prevent ketoacidosis.
Additional Comments from Dr. Stuart Brink:Sounds like the pediatric diabetes specialist did all the proper tests. I would assume that this should include a hemoglobin A1c as well as an islet cell and GAD antibody since the two antibodies would give us information about current inflammation going on in the pancreas while the hemoglobin A1c would provide an estimate of high sugars over the past few weeks. With normal blood glucose readings before and after eating then we can say that the pancreas is currently making enough insulin.
There have been several studies showing that occasional high blood glucose readings during an illness predispose to a higher risk of developing type 1 diabetes for children but not automatically so. We usually do somewhat similar followups and pay close attention during future illnesses to urinary sugar, urinary ketones and blood glucose readings since stress--like during an illness, major family or school turmoil, accidents, operations or growth spurts--are the times when diabetes is likely to show up. We would recommend several more visits to double check A1c and antibody status. The more times things are completely normal, the safer to say this was a strange occurrence and nothing more.
Additional Comments from Dr. Kenneth J. RobertsonYour doctor is quite right. He can't predict what is round the corner. However, there is plenty of evidence that children who are stressed (for example, with a viral infection) may have transiently high blood sugars with spill-over into their urine. This disappears. It is a trap to assume that they have diabetes and the lack of any symptoms of thirst, excessive urine and weight loss indicate the short term nature of the problem. If you find no urine sugar for a couple of weeks of normal diet then I would stop testing and forget about it.
Original posting 10 Oct 1999
Additional comments added 13 Oct 1999
Posted to Diagnosis and Symptoms
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Last Updated: Tuesday April 06, 2010 15:09:06
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