February 20, 2010
Diagnosis and Symptoms, Hyperglycemia and DKA
Question from Hesperia, California, USA:
In November 2009, my five-year-old son started complaining of abdominal pain and started wetting himself during the day then at night. He weighed 44 pounds in July for his physical and weighed 37 pounds in November. We notified his doctor and he did a three hour GTT. They said he was hypoglycemic and to check his sugars twice a day and make sure he has small frequent meals. In December, we noticed his sugars would be 200 or 300 mg/dl [11.1 or 16.7 mmol/L] before a meal. His sugars were constantly up and down and the next day, his blood sugar would be in the 60s mg/dl [3.3 to 3.8 mmol/L]. In the beginning of January, his doctor sent him to the Emergency Room (ER) for a blood sugar of 389 mg/dl [21.6 mmol/L]. By the time the ER checked his sugar, it was 174 mg/dl [9.7 mmol/L] after four hours of no food. He was sent home and his doctor ordered laboratory work on January 11. We just received the results: C-Peptide was 5.8; Insulin serum was 44.9; GTT – fasting–74 mg/dl [4.1 mmol/L]; one-half hour–107 mg/dl [5.9 mmol/L]; one hour–59 mg/dl [3.3 mmol/L]; two hours–64 mg/dl [3.6 mmol/L]; three hours–105 mg/dl [5.8 mmol/L]; and his A1c was 5.4.
The doctor is sending us to an endocrinologist, but we couldn’t get an appointment until April 29. In the meantime, the doctor said not to check his blood sugars anymore and wait for the appointment. She didn’t explain what the results might mean. Should we continue to monitor his sugars? What DO the results mean? He is giving us a really hard time about eating and we have cut out his sugars and carbohydrates since December. Any feedback would be really appreciated. I’m lost and don/t understand what to do.
Answer:
This could be the beginning of diabetes. None of the symptoms you describe are from hypoglycemia and the mildly low value of 64 mg/dl [3.6 mmol/L] is nondiagnostic. When the pancreas is beginning to die off from presumed inflammatory changes that cause type 1 diabetes, sometimes there is a period of time when there is a faulty thermostat: sometimes too much insulin and sometimes too little insulin is produced in response to food intake. That would explain the sometimes high sugar levels and sometimes normal values. It is important to test antibodies: islet cell, IA2, GAD-65, insulin and the newest ZnT8; the more abnormal, the higher chance of this being type 1 diabetes although the antibody tests are not perfect either.
I would continue blood glucose testing because knowledge about when the blood sugar levels stay persistently high will be important to prevent your child from getting dehydrated or going into DKA (diabetic ketoacidosis). I do not agree with your doctor’s advice to ignore the testing; this makes no sense to me at all. Weight loss is potential dehydration and you also should be checking weights frequently to know what is going on with his weight balance.
Lastly, you should call back the endocrinologist you are scheduled to see in April and ask the secretary to place your name on a waiting list. Like most doctors who are busy, people change appointments all the time and you will likely get an appointment within the next one to two weeks. You can also call back the secretary every two or three days and ask about filling in for a cancelled appointment.
SB
