August 29, 2006
Diagnosis and Symptoms
Question from Tucson, Arizona, USA:
My eight year old son was diagnosed with type 2 diabetes in March 2005. In 2006, he was diagnosed with type 1. In August 8, 2006, he was diagnosed with type 1 with negative antibodies, but with a probability he could be type 1.5 (combination of both types 1 and 2). Be advised that all three diagnosis have been from three different doctors. My son has tolerance to high blood sugars and has never had positive ketones.
His blood sugar has reached over 600 mg/dl [33.3 mmol/L], but he has not required medical attention. He sweats excessively, does not urinate frequently, nor drink water frequently. At times, his skin appears to be pale, off color, and, at times, yellowish. He was never obese, but he has lost weight and his appetite has decreased. His high blood sugars have not been controlled and the doctor have directed me to increase insulin every three days, two units. He is currently on 20 units, but it has made no difference. Plus, when the chart says he should be low, he is actually high and the same applies for low. He is very rarely low. He usually goes to bed with a blood sugar over 200 mg/dl [11.1 mmol/L] and will wake up between 95 and 100 mg/dl [5.3 and 5.6 mmol/L]. When he has been over 450 mg/dl [25 mmol/L], he will wake up at 150 mg/dl [8.3 mmol/L].
I am concerned that the doctors are not providing my son with the adequate medical attention. He does not appear to be the typical type 1 or type 2 diabetic. I need answers or direction as to what I have to do. I need to lower my son’s sugar levels but, at the same time, I have great concern for his health. My son is not the same child he was before being diagnosed. There are times where he does not look well, but not once has he demonstrated fatigue. One can tell he is not right by looking into his eyes. All tests came back normal from the laboratory. The doctor did mention that his pancreas was producing low levels of insulin. Are the doctors missing something? Is he being misdiagnosed? Summary: Juvenile, hyperglycemia, negative ketones, excessive sweating, weight loss, never been obese, loss of appetite, backwards symptoms of high or low levels, does not urinate frequently, no excessive thirst, paleness, slight complaints of abdominal pain, bruising easily, and unusual demeanor.
Answer:
It is impossible to make an Internet diagnosis. What you describe does not make much medical sense, however. When we see such problems, we usually revert to basics: strict timing and portion control of meals and snacks, carbohydrate counting, strict blood glucose monitoring before and one to two hours after each food intake looking for patterns and including overnight monitoring. This almost always answers the questions. Occasionally, there are people who use insulin differently and have different peaks and valleys of their insulin effect. Once this is known, then rebalancing can occur. We usually use Lantus twice a day as basal insulin with either Humalog or NovoLog prandially based upon an algorithm for correcting high and low sugars plus insulin to carbohydrate ratios. In any case, whatever system you use, you should be working closely with the diabetes team to get answer to such questions since these types of problems are solvable. If he needs a reverse ratio of higher morning and lower bedtime Lantus, the blood sugar monitoring will show this fact to you by analyzing the pattern on a graph. We would routinely download the memory meter every month and you can do this yourself weekly with free software from the meter companies at their web sites. Testing for thyroid, celiac, and adrenal problems would also be helpful, if not already done. Whether or not he has antibodies or not is useful for research but not helpful for treatment decisions usually.
SB
