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February 23, 2007

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Colorado Springs, Colorado, USA:

My four-year-old son, weighing 38 pounds, recently had an OGTT after the pediatrician found ketones in his urine. The doctor's office had checked his urine after an episode of frequent urinating. The laboratory gave him 75g of glucose for the test. His fasting blood sugar was 57 mg/dl [3.2 mmol/L]; one hour was 201 mg/dl [11.2 mmol/L]; two hour was 214 mg/dl [11.9 mmol/L]; and his three hour was 161 mg/dl [8.9 mmol/L]. He tested negative for GAD-65 antibodies and his A1c was 5.0. We have monitored his blood sugar at home. Fasting sugars were all below 80 mg/dl [4.4 mmol/L] and his two hour post meal readings have never gone above 127 mg/dl [7.1 mmol/L]. Is it possible the glucose load caused a false positive reading in the OGTT? Do we continue to monitor his blood sugar?

Answer:

It sounds like he has what is called glucose intolerance and this often, but not always, leads to frank diabetes. He should be seen by a pediatric endocrinologist who can then follow him closely, track antibodies, pancreas response and give you specific advice for meal planning, blood glucose testing, what to do/expect on sick days,etc. There is some research evidence that being “strict” and avoiding sugars rests such a damaged pancreas so that the insulin production does not decrease as rapidly as if nothing is done. Exactly when, or if, he may need insulin would depend upon follow-up blood glucose, A1c, antibody levels, etc. Excess glucose given for an OGTT could cause high blood glucose spikes, but the dose is based upon his weight.

SB