
January 8, 2004
Diagnosis and Symptoms
Question from Corpus Christi, Texas, USA:
My daughter had been complaining that it hurts when she urinated and would comment that she was not feeling well. She has been potty trained since the age of 2 and is now nearly 4 years old, so when she had three accidents during the week I took her to her pediatrician expecting to hear she had, at most, a UTI. I was surprised when the doctor came in and told me that she had large ketones and her blood sugar was 286 mg/dl [15.9 mmol/L]. She told me that she was 95% sure that my daughter had type 1 diabetes. She called ahead to the Children’s hospital and arrangements were made to have her admitted.
As soon as we were in our room, approximately 1-1/2-hours later, her sugar was down to 66 mg/dl [3.7 mmol/L] but her ketones were still large. She was put on a carbohydrate diet and the nurse brought up some french fries that she gobbled up. Before long her sugar went up to 77 mg/dl [4.3 mmol/L], and during the day and that night her sugar was normal but she continued to show moderate ketones in her urine.
I was repeatedly asked if she had lost weight or was very hungry. I had not noticed weight loss but my daughter thin. She weighs 32 pounds. She was placed on an I.V. to flush out the ketones (that’s what I was told). By the next morning the dipstick showed a trace and eventually no ketones were detected. The doctor came in and told us that we could go home and that the tests — fasting blood sugars, urine test from catheter, and blood test — indicated that she did not have diabetes and her discharge papers showed a diagnosis of hyperglycemia. After researching on the Internet and from what the pediatrician said I am still confused as to how and why she could get so sick and then it just go away. The day she got sick she was being babysat by her grandma who said that she was very thirsty and she ate 6 slices of toast bread with butter.
Answer:
By definition, diabetes mellitus exists when:
the fasting serum glucose level, as measured from a vein (not a fingerstick) is more than 125 mg/dL (generally with a second sample for confirmation) OR;
when a random serum glucose from a vein (not a fingerstick) is > 200 mg/dL, if there are classic symptoms of increased thirst, increased urination, weight loss, etc OR:
if during a formal, properly done oral glucose tolerance test, the 2 hour serum glucose from a vein (not a fingerstick) is > 200 mg/dL.
You know that expression that “not all that glitters is gold”? Well, not all that is hyperglycemia is diabetes.
There are many potential explanations as to why your child had elevated glucose and ketones noted. These are questions best directed to your doctor or pediatric endocrinologist. Your daughter having “impaired glucose tolerance” is one of them and they might wish to pursue further testing.
For the time being, I know you are pleased that she does not have diabetes at this time.
DS