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July 20, 2004

Hyperglycemia and DKA, Other

Question from Chicago Heights, Illinois, USA:

My daughter has had, on four occasions, since 1996, high blood sugars. The first time we woke to find her in distress. She would not wake up and her breathing was fast and shallow so we rushed her to the Emergency Room (ER) and they started to run a battery of tests. They came out and told us that her blood sugar was 698 mg/dl [38.7 mmol/L] and that she was a diabetic. She was admitted to the Intensive Care Unit (ICU). Just five months earlier, my husband was diagnosed with type 1 diabetes. However, they did not start insulin right away and the blood sugar started to go down gradually. By the third or fourth day, her blood sugar was normal. They did not find any other illness. They ran an islet cell antibody test, which came back negative. They told us to monitor her blood sugars at home, especially if she is sick. Two years later, she was very lethargic and would not wake up. I had tested her blood sugar and it was 489 mg/dl [27.2 mmol/L]. I took her to the ER where she was admitted and started the tests again. Within a few days, it was normal again. This time, they did a glucose tolerance test and it came back normal. On the third time, a day or two later, she was sick with some kind of an intestinal bug which caused her to be admitted to the ICU of the Children's Hospital. On the second day of hospitalization, her blood sugar was in the 300's (mg/dl) [16.7 to 22 mmol/L] and it stayed that way for two days until they started insulin, which she received for three days until she started to get low blood sugars. A couple of days later her blood sugar started to go up again, to the 200's (mg/dl) [11.1 to 16.3 mmol/L] so they gave her nothing to eat or drink. Her blood sugar went down after a day. About two weeks ago, she was sick, nauseous and very tired. I checked her blood sugar and it was elevated, in the 200's (mg/dl) [11.1 to 16.3 mmol/L]. Her pediatrician said to give her small amounts of apple juice and monitor her blood sugar, but, if it got to 400 mg/dl [22.2 mmol/L], to take her to the ER. It reached 320 mg/dl [17.8 mmol/L]. Later that evening, it started to go down and she was running low in the 50's (mg/dl) [2.8 to 3.2 mmol/L] for a few days. On the other occasions when her blood sugars where high and they did come down, she ran low, in the 50's. (mg/dl) [2.8 to 3.2 mmol/L]. We have seen three different endocrinologists at three different Children's Hospitals. We have moved a lot because of my husband's job, but they all had her records of the other hospitalizations. No one has given a reason as to why this happens and they do not say if they think she is at high risk of becoming a diabetic. They just tell us to check her sugars when she is sick since we have the meters because of her dad being diabetic. I just do not know what to think.

Answer:

What an interesting story. I’m sorry that I do not know exactly what your question is. I am afraid that I am unable to give you an explanation as to why your daughter has had these strange, temporary glucose elevations. It is NOT diabetes, because diabetes is sustained. Could it be a degree of glucose intolerance and forewarning of later diabetes? Maybe. Even if that were the case, we have no treatment to prevent the onset or development of diabetes, so the advice you’ve been given seems sound: check her glucose levels. Perhaps watch her diet.

I’ve used this example before: you’ve heard that “not all that glitters is gold”? Well, not all that is hyperglycemia is diabetes. Other hormonal conditions that lead to increased stress hormones such as adrenaline and cortisol can lead to temporary elevations in glucose. Perhaps the higher glucose readings that your daughter experienced were a consequence of those associated illnesses.

DS