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March 6, 2012

Diagnosis and Symptoms

Question from College Station, Texas, USA:

During a visit to the pediatrician for painful urination (one day's duration), sugar was found in my five-year-old daughter's urine, prompting a finger poke, which yielded a 250 mg/dl [13.9 mmol/L]. One hour later, she had a normal blood sugar level. The next day, during a glucose test, her blood glucose was 238 mg/dl [13.2 mmol/L] one hour after the drink. Her blood glucose normalized by hour two. In late November, her A1c was 5.2. More recently, it was 5.5. Results of Ipro (MiniMed Continuous Glucose Recorder): initial insertion was 200 mg/dl [11.1 mmol/L], however, postprandial spikes were no higher than 142 mg/dl [7.9 mmol/L]. Her C-Peptide was 0.3 after 12 or 13 hours of fasting though. She is thought to be honeymooning with type 1, however, she has had no symptoms (excessive thirst, urination, etc.). She is highly emotional and I wonder if her angst causes temporary hyperglycemia. There is no diabetes in the family thus far. She is slender, active, healthy looking. Could there be another explanation here? Please give me hope in the form of other illnesses or disorders we could look for.

Answer:

I think the most important thing here is that you not ignore real diabetes and let her go into diabetic ketoacidosis. Watch for the real symptoms of diabetes, thirst and urine, as well as getting up at night to go to the bathroom (or bed wetting). That said, I see lots of kids where there is not any diabetes in the family, where they went to the Emergency Room for something else and glucose is elevated. Little diabetes emerges from this and, likewise, stress hyperglycemia from an illness leads to little diabetes. It is just the times that it does that preventing DKA is the key.

There may be a center that can look for antibodies associated with diabetes. If negative, that is somewhat helpful, but not total security. The most important thing here is not to miss diabetes and let her get sick. Beyond that, you cannot prevent type 1 diabetes in a five-year-old.

LD