May 31, 2005
Diagnosis and Symptoms, Honeymoon
Question from Bakersfield, California, USA:
My son has had high blood sugars since birth. Recently, after two seizure episodes, he had a blood sugar of 220 mg/dl [12.2 mmol/L] four hours after the seizure and six hours after eating anything. The Emergency Room doctor referred us to an endocrinologist at the Children’s Hospital. We have seen her two times and we were testing my son’s blood sugar three times daily. Her conclusion, right now, is that my son is weird, but needs watching.
His A1c is 5.8 (as of two weeks ago) but has been upwards of 6.9;
His antibodies test was negative;
His blood tests show his pancreas isn’t producing enough insulin;
His blood sugars range from 125 to 270 mg/dl [6.9 to 15.0 mmol/L] fasting and he has registered a blood sugar as high as 316 mg/dl [17.6 mmol/L];
Has had several dip sticks for ketones come back High (around 160 mg/dl [8.9 mmol/L]).
The endocrinologist said she doesn’t want to give him any insulin yet, as she doesn’t want him experiencing lows. His blood sugars are higher recently than in the past two and a half years, but they don’t seem to be affecting his A1c level at all.
We were told to stop doing the three times a day testing and just test once in a while. What are your opinions on this? Does it sound right to you? Could he just be in a long honeymoon phase?
Answer:
What you are describing is very unusual for typical diabetes. Sometimes, as the beta cells are dying, they intermittently function and this could explain what you are documenting. Also, antibody tests are only positive about 60 to 80% of the time even with inflammatory changes in the pancreas so negative tests are less helpful with diagnosis than positive ones. I would stay in close contact with your diabetes team and also continue to be vigilant with symptoms of either hypoglycemia or hyperglycemia, especially during illness periods of time. Many, but not all, pediatric endocrinologists would suggest more rather than less monitoring in situations where it is not clear what is happening and what may be changing. You should go back and discuss this with your pediatric endocrine team so that all of you are comfortable with what type and how much monitoring is needed, etc. Time will probably help sort this out.
SB
