Lg Cwd
icon-nav-help
Need Help

Submit your question to our team of health care professionals.

icon-nav-current-questions
Current Question

See what's on the mind of the community right now.

icon-conf-speakers-at-a-glance
Meet the Team

Learn more about our world-renowned team.

icon-nav-archives
DTeam Archives

Review the entire archive according to the date it was posted.

icon-question-mark
April 3, 2007

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Nevada, Missouri, USA:

Out of pure curiosity, my husband and I took our two-year-old daughter's blood sugar. It was 321 mg/dl [17.8 mmol/L] and the word "ketones" was flashing on the screen. She had refused lunch earlier in the day, but had been to a birthday party after that and consumed a lot of cake and ice cream, about four hours prior to the test. I took her to the Emergency Room (ER) and they made me feel completely lousy for even bringing her in. Upon arrival, her blood sugar was 179 mg/dl [9.9 mmol/L]. Within one hour, it was down to 97 mg/dl [5.4 mmol/L}. The doctor told me we had nothing to worry about. Two days later, she began to shake and sweat profusely, screaming at us to put her down (I hear this is symptomatic of LOW blood sugar). Paranoid, I took her back to the ER, where they diagnosed her with a severe inner ear infection. I decided to go ahead and asked them to test her sugar before I went home and worried again. The doctor was upset at my request and the nurse told me that she thought I was "being cruel." When the test was complete, her blood sugar was 167 mg/dl [9.3 mmol/L]. The nurse told me that it was not a bit high, although my daughter had not eaten for five hours. The next day, we took her to a regular pediatrician the and he laughed at us. We went directly to the Health Department and had her sugar checked. It was 89 mg/dl [4.9 mmol/L], after fasting for seven hours. I just need some answers. I am going crazy and while I truly hope there's nothing wrong, I would rather be paranoid then wait too long to investigate. We have no significant history of diabetes. Only my husband's grandmother and she only takes oral medications.

Answer:

Your health care people should not have laughed at you! They should have helped to clarify and educate you.

First of all, it may make a difference as to which glucose meter you used and whether it required proper “coding” to match the test strips with the meter. The glucose reading over 300 mg/dl [16.7 mmol/L] was CLEARLY ABNORMAL. It does not mean the child has diabetes, but it certainly warranted confirmation. Please refer to similar questions related to the diagnosis of diabetes, but I’d now suggest that you carefully review the meter type that you have, code the strips appropriately, if necessary, and learn to carefully obtain the child’s blood glucose. I’d suggest that you check BEFORE breakfast, BEFORE lunch, BEFORE dinner, and BEFORE bedtime for one to two weeks.

A normal FASTING glucose should be less than 100 mg/dl [5.6 mmol/L], but you must recognize that these glucose meters are not 100% accurate; they should be 85 to 90% accurate. (In other words, the value can be off by approximately 10%. So, a value that SHOULD read “100” might read out as low at 90 but as high as 110.)

The other glucose levels should be similar, but I’d not be too concerned IF she had no symptoms of diabetes (e.g. increased urination and increased thirst, or weight loss, or increased fatigue, or yeast infection), AND the glucose were less than about 140 mg/dl [7,8 mmol/L].

If you still have questions, ask your doctors for a referral to the Diabetes Clinic at the Children’s Hospital in Kansas City. They also used to have outreach clinics in southwest Missouri in either Springfield or Joplin, and in southeast Kansas in Pittsburg.

For some of the meters, when the glucose is more than 240 mg/dl [13.3 mmol/L] or so, it will flash the suggestion to check for “ketones.” While ketones are not uncommonly present in patients with type 1 diabetes and high glucose levels, we ALL can produce ketones under certain situations, especially those associated with prolonged fasting.

The glucose level of 89 mg/dl l [4.9 mmol/L] after seven hours of fasting is perfectly normal. The glucose of 167 mg/dl [9.3 mmol/L] after five hours of fasting is a bit suspicious, but again, stress can lead to modestly elevated glucose levels.

By the way, I know exactly where Nevada, Missouri is. For the uninitiated reader, you’d think that it was pronounced “Ne-VAH-duh”, like the U.S. State, but it is pronounced “Ne-VAY-duh”.

DS