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July 6, 2000

Diagnosis and Symptoms

Question from Algeria:

I am an Algerian citizen, and I am doing my best to submit you this letter in English, so all my apologies for mistakes. About 6 months ago, my sister's son (11 years old) had hyperglycemia (3,4) which gave way after a diet. About a month ago, the diagnosis of the doctor was renal diabetes (glycemia 1,10; glucosuria 3X). Recently, after blood and urine analysis: glycemia: 1,50 and 1,80; glucosuria 4X, acetone: negative. Repeated, glycemia 2,5 and after 3 hours and a meal became: 1,1; acetone: positive. The doctors here are hesitating about the diagnosis and don't know about the adequate treatment. My sister is very worried -- her son is still losing weight (32 kg). What are your opinions? P.S: The family of my sister's husband has members with diabetes.

Answer:

We are having some difficulty interpreting the way you express blood sugar levels and you may have to reply to clear this up. The first time, for instance, you write hypoglycaemia (3,4).

Does this mean 3.4 mmols/liter which is a little low — i.e, Hypoglycemia not Hyperglycemia) or does it mean two separate assays of 3mmol/l and 4mmol/l. Likewise when you say glycemia 1,50 and 1,80) does this mean 1.5mmol/l and 1.80 mmol/l. We can easily translate mmol/l to the mg/dl used here; but have been puzzled by your use of the term ‘hyperglycemia’ when these blood sugars seem to have been rather low and more appropriate to ‘hypoglycemia’. If you could write and clarify this we could reply more helpfully.

In the meantime, the impression I have is that there is no elevation of blood sugars; but a definite glucosuri a. To decide whether this is a single primary congenital renal tubular dystrophy with glucosuria only would require further tests to make sure there is no aminoaciduria or phosphaturia as well. I am quite sure that this is not autoimmune diabetes though.

DOB