June 2, 2001
Daily Care
Question from Cape Town, South Africa:
My two and a half year old daughter has had type�1 diabetes for almost six months. While we have had a few highs and lows with her sugar readings, the A1c test revealed 4.9 and 4.7 mmol/L [88 and 85 mg/dl] levels. We inject her with a daily morning dose of 3.5 units of Protaphane, and if necessary, 0.5 Actrapid insulin.
Recently and at present, we noticed an almost fruity-like smell on her breath, though our daily ketones test reflects negative and regular finger pricks reflect readings within the 4.8 to 12 mmol/L [86 to 216 mg/dl] range. Can you explain the fruity-like smell on my daughter’s breath? Why does my daughter cry about pains in the leg(s), which she had experienced on occasions during the night?
Answer:
Sometimes in small children, ketones may be present on the breath even though they are not detectable on a urine dipstick.
Electrolyte disturbances secondary to wide fluctuations in blood sugar often lead to cramps in the feet which are really painful, especially during the night. They generally have no consequences and disappear in a short period of time.
Your daughter’s hemoglobin A1c values seem to be good (if expressed as % and not mmol) as does her insulin regimen.
MS
