January 8, 2000
Hyperglycemia and DKA
Question from North Carolina, USA:
I took my 6 year old for a routine check up on 8/20. A urine test was positive for sugar. He is asthmatic and had been on steroids for 5 days beginning 7/22. A repeat test on 8/26 was again positive. They did a finger prick glucose test which was 305. The doctor on duty thought it could still be due to the steroids. The doctor who saw him on 8/20 phoned on 8/27 and told us he had diabetes. We saw an endocrinologist on 8/27. They did the H1c test, and showed us how to monitor his blood glucose over the weekend with a monitor. They asked us to restrict his sugar, test it before each meal and record the results as well as keeping a journal of what he ate. We were instructed to call if his blood glucose was more than 400, or if a stick test done in the middle of each day showed more than a trace of ketones.
The weekend went fine. On Monday morning when I went back to meet with the endocrinologist, they were extremely surprised with the results. Blood glucoses between 76 and 123. The HbA1c test came back as 6.9%. They sent me home with instructions to put him back on a regular diet and check his blood glucose every couple of days. I am still keeping a journal of his diet, checking his urine once a day with a the stick test (which has always been negative), and checking blood glucose every other day. today before dinner it was 86. I am overwhelmed with his being diagnosed as a diabetic, and now I don’t know where to go. Is it possible that the steroids caused the positive urine test after so long? Why would his blood glucose have been 305, and now everything appears to be normal. Should I be concerned about the results of the H1c being so close to the diabetic line or is this normal in a 6 year old? Should I continue on the course suggested until something happens, or seek further explanation for the cause? Any answers would be greatly appreciated.
By the way, there is no known history of diabetes on my side of the family. My husband’s father has adult onset controlled by diet and a pill. I do recall during my pregnancy something about diabetes and weight of the baby, but I thought that applied to the mom. My now 6 year old was 9 lb. 2oz.; his 3 1/2 year old brother was 9 lb. 14 oz. There were no other symptoms present at or before testing. Does he have diabetes?
I think that it is probable that the stress of the asthma and then of the threat of diabetes with all the testing involved was enough to account for the brief rise in blood sugars. Because the A1c test seemed a little high, although that might have been a function of the methodology used, the wisest step to take to allay anxiety about diabetes might be to have an antibody test for by far the commonest form in young people in the US. i.e. Type�1A (autoimmune) diabetes. Your doctor could call 1-800-425-8361. A glucose tolerance test might be easier; but would be less convincing. The negative family history does not exclude Type 1 diabetes. I am assuming that the blood sugars may not always have been taken fasting and that there has been no evidence of glucose in the urine.