July 21, 2020
Diagnosis and Symptoms
Question from Canada:
My 10-year-old daughter has had three major surgeries in the past two years. After the last two, she had very obvious signs of high blood sugar including losing 5 pounds (she is low normal BMI to start with), excessive hunger, excessive thirst, and excessive urination including getting up at night. Both my husband and I have first degree relatives with type 1 diabetes so we are familiar with the signs/symptoms. The first time it happened we contacted our family doctor who ran an A1c, which was normal, and a random glucose, which was also normal. Things seemed to resolve about 3 to 4 weeks after that surgery. This past surgery she has had alarmingly frequent urination, every 30 to 60 minutes, which we had tested to rule out a UTI. It was negative for sugar but positive for ketones. She has also lost weight again. I don’t want to put her through more testing as she has already had enough medical procedures to last a lifetime…but, if she does have diabetes, we want to catch it early. Could this be stress causing temporary high blood sugar? Could it be that she received steroids for one of the surgeries (but not the others)? Or, should we check her blood sugars ourselves on a home meter? I haven’t done this because I don’t want to add any stress to her life.
The A1c gives you the equivalent of an average blood sugar for the previous 2 to 3 months, so it may not be the key test to make a diagnosis. Random blood sugar just lets you know the sugar level at that moment. Similarly, urinalysis lets you know how the kidney is handling the sugar levels for the previous few hours. The positive ketones just indicated she was not getting sufficient nutrition for those few hours and so was using her body’s reserve, body fats, to supply energy. So, normally there would be positive ketones at that moment.
If your daughter were my patient, I would agree and encourage some home blood glucose monitoring for about a week: pre-meals and about 1 to 2 hours post-meals would provide excellent information. If there were only intermittent high blood sugar values, this could be something called pre-diabetes. Any steroid treatment of any kind often will raise blood sugar levels, especially if there were post-surgical stress in someone who is otherwise predisposed to developing diabetes. If there were still some doubt after such blood sugar monitoring, then diabetes blood antibody tests would also be worth considering since these, too, can be positive earlier than formal diagnosis with persistent high blood sugar levels. Islet cell, insulin, GAD, ZnT8 antibodies can all be tested through most commercial laboratories. If there were any question of high blood sugar levels, even if only intermittent, with such symptoms, then consultation with your local pediatric diabetes specialist should be considered, of course.