April 25, 2004
Diagnosis and Symptoms
Question from Lyons, Kansas, USA:
I have a nearly five year old boy who has recurrent blood sugars greater than 300 mg/dl [16.7 mmol/L]. These occur without provocation that the mother can define. Two months ago, his mother came to me. I dispensed a blood glucose home device and he was found to have several days of “roller coaster” blood sugars from 80 to 310 mg/dl [4.4 to 17.2 mmol/L]. At that time, he was having urinary frequency and urgency. He saw an endocrinologist who hospitalized him for four days, ran tests, but never came back with a definitive diagnosis. He was told to go home and just keep an eye on him. Yesterday, his mother called me and he had a blood sugar of 308 mg/dl [17.1 mmol/L]. He has also been complaining recently of acute headaches with nausea and vomiting. The urinary complaints have not returned. I have encouraged them to monitor his blood sugars fasting and two hours postprandially, get an A1c, and notify the endocrinologist on Monday of these results. Any idea what could be going on? He recently had a CT (Computed Tomography) of the brain that was normal.
Answer:
Certainly, it is not normal for blood glucose readings to bounce around like this. Sometimes in the earliest phases of diabetes, the pancreas will over and under produce insulin and cause such problems. Occasionally, with bowel dismotility or dumping syndromes there are such hormone-metabolic imbalances as well. I would agree that more monitoring is needed and this child needs to be in the care of a bona fide pediatric endocrinologist/diabetologist to help sort this out, make sure that there are not other problems, such as celiac disease, thyroid, pituitary or adrenal problems, insulin producing lesions of the pancreas, etc. Islet cell antibodies may also be helpful, but only if positive.
SB
