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May 25, 2007

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Amsterdam, New York, USA:

We took my two-year-old daughter to the Emergency Room (ER) because of a 103 degree fever that had lasted for two days. This was the highest reading so the doctor on call told us to take her to the ER. We had been giving her Tylenol and the ER gave her Motrin and ran a blood test to determine whether it was a bacterial or viral infection. My daughter had been consuming diluted apple juice all day and had very little to eat as a result of being ill. They had to try four separate times to get blood, which caused a lot of stress for her. All blood work came back normal with the exception of a blood sugar reading of 200 mg/dl [11.1 mmol/L]. The ER doctor didn't seem too concerned and attributed the elevated reading to the apple juice and not eating. My pediatrician is having her re-tested (a fasting blood sugar), but says he is not concerned as she is healthy in all respects. He blames the high reading on stress of the event and her illness which turned out to be viral. Does this make sense? There is no family history of diabetes.

Answer:

Your pediatrician is likely correct. A single high blood sugar during illness without any symptoms of diabetes is not clear evidence of diabetes. Your daughter will benefit from further testing.

MSB