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December 3, 2007

Hyperglycemia and DKA, Other

Question from Palo Alto, California, USA:

My 20-month-old son and five-year-old daughter have recently been diagnosed with pre-diabetes and had A1cs of 6.2 and 6.5. We have been measuring and recording results and have sent them off to our doctor. I noticed that when my son has been upset or crying for an hour before I measure his glucose, it seems higher then usual. Normally, his fasting blood sugars are from 110 mg/dl [6.1 mmol/L] to 115 mg/dl [6.4 mmol/L]. When he's upset, he's been in the 135 mg/dl [7.5 mmol/L] to 140 mg/dl [7.8 mmol/L] range. Today was weird. At 9:45 a.m., he was 137 mg/dl [7.6 mmol/L]. Thirty minutes later, he was 112 mg/dl [6.2 mmol/L]. We use alcohol wipes just to make sure there is no contamination. Anyway, how much of a difference does it make in a child when they are upset? Because of his age, we can never predict his mood! In children, since they are growing, does their insulin production work the same as in adults? I would think it would be different as they have not matured yet. Is this why some of their readings can be different? Is it possible that maybe sometimes high results are normal in toddlers when they are upset and the body is learning to develop more insulin? Are there statistics out there for children as young as mine that have been classified as type 2 or pre-diabetic (they were both negative for antibody tests and are underweight if anything) and are able to control diabetes via diet/exercise before having to go on insulin? I understand it is different for everyone, but are there some higher level statistics about this?


Unfortunately, children of this age are usually type 1 and not type 2, unless they have a rare kind of diabetes called MODY. This can be checked with special genetic testing and perhaps your diabetes team has already done this. You should ask them.

You are correct that stress can cause elevated glucose levels. This is a simple adrenaline response. It would happen if any of us, adult or child, were given an adrenaline injection and can also happen internally and automatically. But, if there is not enough insulin available, then the adrenaline glucose response overwhelms the system and high sugar results.

The vagaries of eating and growth as well as hormone production in children and adolescents also accounts for some of these ups and downs but, mostly, I suspect this is because your children’s pancreas is somehow damaged and not responding correctly. Thus, the pre-diabetes diagnosis. The A1c levels you described are too high and consistent with the glucose levels. How you treat them at this age will involve close discussions with your diabetes team and analysis of the ongoing lab results, home glucose readings, etc.


[Editor’s comment: You may wish to review some of the many previous questions and answers we have posted on the Diagnosis and Symptoms of diabetes. Among the information found therein is that antibody tests are positive only 60 to 80 percent of the time.