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January 16, 2001

Diagnosis and Symptoms

Question from Westminster, Massachusetts, USA:

A few weeks ago, my mother noticed that my 11 year old son was drinking a lot (he went through 4 gallons of water and 2 cases of Diet Sprite). Since I am a Medical Lab Technician, I decided to dip his urine for glucose and ketones. He had 4+ glucose and 2+ ketones. My son ate a few Crispix in the morning, but vomited them before noon so I took him to the hospital at about 2 pm where his blood work showed normal electrolytes and a blood glucose of 141 mg/dl [7.8 mmol/L]. Since then he had a fasting blood sugar of 120 mg/dl [6.7 mmol/L] ( normal is 60-100 mg/dl [3.3-5.5 mmol/L]) and then another non-fasting blood sugar with of 108 mg/dl [6 mmol/L]. No one seems to know what to make of these results; they believe I may have caught diabetes early. What would be the nest step in his care? I have continued to do glucose and ketone checks and have altered his diet (no more Pop-Tarts for lunch). He's been positive for ketones up to 4+ and glucose has been between normal and 4+. He's been good for the past three days with negatives for both. It's been two weeks now and I would just like to get a handle on this. I feel frustrated, and I really don't know what I can feed my child.

Answer:

I think that there can be very little doubt that your son has diabetes. The most probable form by far is type 1A diabetes. In this condition, an abnormal autoimmune process sensitises a group of T-cells to infiltrate the islet cells in the pancreas, and, over a number of years, to slowly destroy their ability to produce insulin. In these circumstances, it is easy to understand how it is quite common in the period when insulin production is marginal for any additional stress such as a mild infection to produce transient phase of clinical diabetes.

At this point I would not just await events. Ask your son’s doctor to arrange a confirmatory antibody test. The risk of deferring a firm diagnosis is that a more serious infection such as the flu might precipitate an episode of frank DKA [diabetic ketoacidosis]. If the test comes back positive, which I think it will, I would try to arrange for your son to be seen at a pediatric diabetes Center where there will not only be a pediatric endocrinologist; but a nurse educator, a dietitian, and a medical social worker to help.

There are some other much less likely possibilities. For instance, if your son is overweight and there is a strong family history of diabetes in the middle years, he might have type 2 diabetes.

DOB