My 16-month old son, who weighs 20 pounds, has had very little appetite lately. The past few days he has been EXTREMELY cranky and, this morning, refused to eat anything. Because I have had type 1 for 28 years, I used my meter to check his blood glucose, which was 322 mg/dl [17.9 mmol/L]. I am very worried and don’t know if this definitely means diabetes. Should I keep testing at different intervals and then present doctor with my findings? Am I just being paranoid? I don’t think he is urinating more than usual, but it is hard to tell with him in diapers. I do know that he is small for his age.

While you indicated that it is difficult for you to determine whether your child is having an increase in urination because he is in diapers, you did not comment whether he was demonstrating increase in thirst. You have indicated that on a single occasion, you found his blood glucose to be extremely elevated at 322 mg/dl [17.9 mmol/L]. Assuming that you did the test correctly, with his skin properly prepared and clean and dry and with the meter properly calibrated (if required), then this result is absolutely abnormal. As you have type 1 diabetes yourself, you, hopefully, check your own urine (or blood with the proper meter) for KETONES when your blood sugar is more than 240 mg/dl [13.3 mmol/L] (some clinicians will ask for a check if the glucose is more than 300 mg/dl [16.7 mmol/L]): did you check your son for ketones?

Does your child have diabetes? I don’t know. I wouldn’t base any diagnosis from a single test without much corroborating history or physical examination findings and/or other supporting laboratory results. But, with crankiness, diminished appetite, poor weight gain, elevated blood glucose, AND the presence of ketones in blood or urine, I would be thinking of diabetes mellitus, too!

As a rule, REGARDLESS of the glucose information you provided, the most important things that you have indicated include that your son is not acting like himself (cranky and with diminished appetite) and he may be underweight. Whether or not your child actually has diabetes, CALL YOUR PEDIATIRICIAN and make an appointment right away. In the meantime, I would say that it would be reasonable to have you check some additional glucose checks (with properly prepared skin-prick sites) before meals (and maybe two hours after) and urine ketone tests, if glucose is greater than 240 mg/dl [13.3 mmol/L]. If judging and collecting his urine output is difficult for you, why don’t you switch to cloth diapers for a day or two?

Finally, if your son begins to vomit or has difficulty arousing or other new concerns, seek local urgent (or emergency) medical advice in person immediately!

Let us know what happens, please.

DS