From London, Ontario, Canada:
Our three month old son is in the process of being diagnosed with type 1 diabetes. We brought him into the childrens hospital recently for what we thought was a simple twitch in his right leg. The doctors were not sure what the problem was so they felt it was necessary to perform a blood test, urine test and lumbar puncture since we have has some cases of meningitis in our area. All three tests came back with high blood sugar levels (38-40 mmol/L [684-720 mg/dl] ). With this, our son was admitted into the hospital. He is being treated for diabetes while our doctor evaluates all the possibilities. The treatment is working well, but our son is 5.7 kilograms and receives 6 units of NPH in the morning and 3 units of NPH at night. He also gets between 0.5 and 1.5 units of Humalog at each time depending on his glucose reading.
The twitching in his right leg has turned out to be seizure activity. He had an EEG which showed seizure activity on the left side of the brain. An MRI and CT Scan followed a few days later. The MRI showed some calcium deposits in the same area as the EEG showed the seizure activity. The CT Scan verified this. Our neurologist thinks that our son may have has a stroke approximately two weeks before the CT Scan, which coincides with when we first noticed the twitching. It may also be a spot in his brain that did not develop properly. Either way, the long term effects are not very clear because he is so young, and they do not know what the problem is yet.
To conclude, our doctors really do not know what is wrong with our son. He may have type 1 diabetes or it may be a transient form of post-natal diabetes, and his seizures may be caused by a stroke or by an improperly developed spot in his brain. They are not sure if the two problems are linked (most likely not) and are trying to find answers to all the questions that arise.
We are very happy with the job that our medical team is doing, but are looking for help from other doctors who may have seen similar things in such a young patient.
A number of possibilities come to mind on reading your son's story although I am sure that his doctors are already exploring them. One is that he may indeed have type 1A (autoimmune) diabetes and this could rather easily be disposed of by doing a simple immunofluorescent screening test for islet cell antibodies. This is not entirely specific and if positive could be followed with the orthodox three antibody immunoassay.
Another is that he has transient neonatal diabetes with an abnormality on Chromosome 6 especially what is called uniparental (paternal) disomy which could be detected on doing a karyotype. In both of these it would have to be assumed that the diabetes and seizures were separate entities.
Another rare form of diabetes which I think I would put at the top of my list is one called MELAS which is one of the mitochondrial forms of diabetes, the letters stand for Mitochondrial Encephalopathy, Lactic Acidosis and Stroke like episodes including seizures. The diabetes is really secondary to the impaired energy production in the islet cells. There are treatments other than insulin, but the precise diagnosis does involve the help of a rather specialised genetics laboratory.
Finally and a very long shot, it might just be worth testing for an inborn error of metabolism called homocystinuria which can be associated in children with strokes due to intravascular clotting. It has been of some interest recently in connection with the complications of type 2 diabetes.
He seems, by the way to be on a rather high dose of insulin, almost 2U/Kg body wt/day.
Original posting 23 Jul 2001
Posted to Diagnosis and Symptoms
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Last Updated: Tuesday April 06, 2010 15:09:24
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