November 14, 2006
Diagnosis and Symptoms
Question from Colorado, USA:
The other morning, my five year old son woke up and was very lethargic and very thirsty. I have been occasionally testing his blood sugar and decided to test him. (I am having problems with my own blood sugar so I have been watching signs in my son also). He was 60 mg/dl [3.3 mmol/L]. I gave him breakfast, which consisted of cereal with milk. Two hours later, he was perkier and I tested him again and he was 188 mg/dl [10.5]. I have some ketone sticks and urine tested him and he tested greater than 160 mg/dl [8.9 mmol/L] that the stick allows for (large). Two hours later, he tested the same way with his blood sugar and ketones. I had him drink a lot of water and then tested him two hours later. His ketones were down to 90 mg/dl [5.0 mmol/L] and his blood sugar was 155 mg/dl [8.6 mmol/L], now four hours after breakfast. I gave him lunch and then tested him two hours later and his ketones were past large again and his blood sugar was back up to 187 mg/dl [10.4 mmol/L] again. I gave him a lot more water and waited three hours longer and the ketones were down to trace, but his blood sugar never went under 140 mg/dl [7.8 mmol/L] the rest of the day. I last tested him at 11 p.m. I monitored him all the following day and he had small to trace ketones and blood sugars were only slightly elevated.
I wanted to know what your thoughts were about this. I have read it is possible to have ketones if one is fasting for long periods; on a high protein/low carbohydrate diet; or sick/vomiting or dehydrated. He was none of these things so, I am wondering if a non-diabetic could ever get large ketones. Or, could this be an early sign of diabetes? If this is not early diabetes, what could it be?
In the past few weeks, I have tested him over around 175 mg/dl [9/7 mmol/L] twice and at 70 mg/dl [3.9 mmol/L] once. I haven’t tested his ketones for months, but he was always normal before. For the past week, he has been drinking a lot more water than normal. The day before this happened he was very lethargic, also.
Answer:
Ketones only indicate that the body is burning fat. So, it could happen with starvation, illness (not eating) – and insulin deficiency. The blood glucose readings you report are definitely abnormal, so I would consult with your physician and consider strongly consultation with a pediatric diabetologist since this could be early diabetes. Rather than wait for him to lose weight and risk dehydration or diabetic ketoacidosis, I would certainly monitor his blood glucose levels closely and see if there are any other markers of diabetes besides the intermittent high blood glucose levels.
SB
