April 16, 2008
Diagnosis and Symptoms
Question from St. Louis, Missouri, USA:
My 14-year-old son has displayed the following symptoms:
Approximately six months ago, he had failing grades. His teachers said he would “space out” during classes and often act “confused.” He has ADD that has been under control for eight years. We thought maybe it was from that.
Approximately six months ago, he began to get more agitated and frustrated with his younger siblings. We figured this was from puberty and was semi-normal.
Over the last year or so, he would be extremely hungry and very agitated when he could not eat. Again, I assumed this was puberty!
Around four months ago, he began to wake in the middle of the night in what we thought was “sleep walking.” He was confused and couldn’t find bathroom. We would try to awake him. When that never worked, we would just walk him back to bed.
Approximately three weeks ago, he began bed-wetting. The pediatrician had put him on Melatonin because he was having difficulty sleeping, but we took him off it, thinking he was sleeping too soundly. It continued even after taking him off.
Two weeks ago, he began having periods where he wasn’t “feeling good.” He would go to his room, cover up and watch movies in the dark. He was also having headaches.
Last Monday, he came home from school again not feeling well. My husband, who is not my son’s biological father, is diabetic so I did a finger stick check on my son. His blood sugar was 303 mg/dl [16.8 mmol/L]. Over the next couple days, I tested him regularly. His blood sugar fluctuated from 58 mg/dl [3.2 mmol/L] to his high of 303 mg/dl [16.8 mmol/L]. Most of his blood sugars were in the 200s mg/dl [over 11.1 mmol/L]. We were never testing until two hours after meals or snacks.
I called the pediatrician who ordered blood work stat. His fasting blood sugar came back “slightly elevated” and his triglycerides and cholesterol were high. His cholesterol was 220. They said our pediatrician needed to see this, but was out of town, so she would look at it first thing Monday morning. Friday night, when he got off bus, my son was dazed and confused, pacing the floor. His blood sugar was 58 mg/dl [3.2 mmol/L] so I made him eat a snack. Thirty minutes later, his blood sugar was 275 mg/dl [15.3 mmol/L]. I called the pediatrician’s office back and asked them to please have another doctor look at it. I expressed my concern because of my son’s low blood sugar. A nurse called back and told me that they wanted to re-do all the tests. I asked for an A1c, too. They did. Today, I got results back. They told me his fasting glucose was 93 mg/dl [5.2 mmol/L], within normal range, this time. His cholesterol and triglycerides were still high. His A1C was 5.7%.
Am I wrong to be concerned with the high and low blood sugars that I’ve gotten at home? Also, he is not overweight. Why would his triglycerides and his cholesterol be high? I’ve made an appointment with the pediatrician to express my concerns. What is your opinion? After putting puzzle pieces together over the last six months or so, I’m greatly concerned now that this is SOMETHING and no one is listening me. Am I wrong?
You are right. Talk to the doctors immediately. It sounds like this could be the beginning of beta cell failure when sometimes the pancreas is able to make insulin, sometimes making too much and altogether not being a normal thermostat for glucose control. This also could explain the high lipids or he could have a separate lipid problem. Has anyone ever checked lipid levels with him previously? In any case, you should do some before meal and one to two hour post-meal blood glucose checks for five or 10 days to see what the actual pattern is and then discuss this with an adolescent diabetologist who can give you more specific advice. For sure, watch his weight and watch the symptoms of excess urination, excess thirst, enuresis, overnight urination, etc. If these are positive and there is persistent hyperglycemia, then he will need immediate attention without any delay to start insulin. Antibody testing also may be helpful to see if these markers are already positive or not.