October 15, 2002
Diagnosis and Symptoms
Question from Shorewood, Minnesota, USA:
For the past couple of months my seven year daughter has been experiencing symptoms of diabetes. She has been losing weight, has been irritable, tired, extremely thirsty, and is urinating very frequently (she has been wetting the bed). She also has been running temperatures (around 101 degrees F off and on, has headaches and stomachaches, her urine has a strong odor, and she has no appetite. My husband has type 1 diabetes and has quite a few relatives with diabetes as well (mostly type 2).
Four days ago, I brought my daughter to the pediatrician who checked a glucose level and it was 201 mg/dl [11.2 mmol/L], so she sent us to a pediatric endocrinologist the next day. There, her fasting blood glucose was 93 mg/dl [5.2 mmol/L], she had large ketones in her urine, and a blood sugar after lunch was 205 mg/dl [11.4 mmol/L], but her hemoglobin A1c test was 4.5%. The doctor said she may not have diabetes after all and sent her home and asked us to test her glucose three times a day and call him with the results. For the past two days, her highest reading has been 145 mg/dl [8.0 mmol/L], and her ketones are now gone. She is starting to get some energy back, but she keeps running a temperature periodically.
Is there another illness that could cause the symptoms she is experiencing? Could she be going through a honeymoon phase? I just don’t want to get my hopes up that it is not diabetes.
Answer:
This is not an uncommon situation. The symptoms your daughter has had are not entirely typical of diabetes. Particularly, the temperatures and abdominal pains (without very high sugar and ketone levels) are more consistent with urinary tract infection. However, the symptoms of diabetes sometimes appear during an infection then recede afterwards because a person still has enough insulin making reserve to cope with normal situations.
In such cases where there is doubt, a glucose tolerance test can help to sort out what is going on. This involves taking a sugary drink and checking blood glucose results before and afterwards.
KJR
[Editor’s comment: See Classification and Diagnosis of Diabetes Guidelines.
SS]
