January 17, 2018
Diagnosis and Symptoms, Ketones
Question from Sugar Land, Texas, USA:
We took our seven-year-old to the Emergency Room because she contracted a nasty stomach virus. She hadn’t eaten in four to five days, had diarrhea, high fever, severe stomach pain, etc. Anyway, when they did a urinalysis, they found ketones in her urine. Twenty to 30 minutes after giving her a Sprite and apple juice, they tested her blood sugar and found it to be 255 mg/dl [14.2 mmol/L]. Her a1c was 5.4 and she was antibody negative. Her blood sugar came down over the next couple hours and she was released. An endocrinologist called us the following day and asked us to come in and pick up a home meter and learn how to test her at home. We did. Over the last month, her morning readings have all been under 100 mg/dl [5.6 mmol/L] and her pre meals have all been 120 mg/dl [6.7 mmol/L] or less. Some of her post meal readings though have jumped up over 200 mg/dl [11.1 mmol/L]. She seems to have good days and bad days. Sometimes her number are all under 120 mg/dl [6.7 mmol/L]. Other days they range from 120 mg/dl [6.7 mmol/L] to 260 mg/dl [14.5 mmol/L]. Her high numbers always come back down with a few hours.
Our daughter is slim and athletic. She doesn’t have antibodies, so it’s not type 1 and she really doesn’t fit the profile for type 2. What could make her blood glucoses so variable? Do we need to be worried that she sometimes jumps up over 200 mg/l [11.1 mmol/L]? We have an appointment with an endocrinologist but it’s not that soon.
Answer:
Antibody levels are only found positive in about 80% of newly diagnosed type 1 diabetes children so this is not an absolute but only relative test result. It sounds like she has what is called glucose intolerance, which can be a forerunner of overt diabetes. Clearly, she needs a meal plan that would restrict fast-acting sugar/carbohydrate intake and provide nutrients in a balanced fashion to try to prevent those intermittent spikes afer meals. More athletic activity and avoiding obesity would be key elements to her therapy approach as well as blood glucose monitoring, A1c monitoring.
You may want to contact the diabetes specialist and see if you can be placed on a waiting list to get an earlier appointment rather than waiting a longer time for consultation. Should she have unexpected and unexplained excess urination, enuresis, weight loss, fatigue, this would indicate need for urgent evaluation the same day as well as immediate blood glucose and urine or blood ketone testing. The higher the blood glucose and the more positive the ketones present, the more urgent the evaluation need either with your own PCP, Emergency Room or diabetologist.
SB
