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November 10, 2009

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Morrisville, Pennsylvania, USA:

I have a seven-year-old daughter who I suspect may have diabetes. Her sister, now 16, was diagnosed at age 12. I have my youngest tested once a year and her A1c has slowly crept up with each passing year. Four years ago, it was 4.4 and, at last check, four months ago, it was up to 5.8. I also know that she had two positive antibodies a few years ago, but I was told she'd have to have three to be diagnosed. I'm not sure if that's correct or not. This past weekend, both of my girls came down with the flu. I have been checking my seven-year-old's blood sugars and, every night, they've been in the 300s mg/dl [over 16.7 mmol/L]. In the morning, when she wakes up, they are always between 78 mg/dl [4.3 mmol/L] to 115 mg/dl [6.4 mmol/L]. I called our pediatrician and he told me not to panic because she has the flu and it causes great stress on the body and will elevate blood sugars. However, is it possible for a child who has not been diagnosed to have a blood sugar that high? I have noticed that she has been waking up in the middle of night to go to the bathroom and has been drinking more, all of which could be attributed to her having the flu and drinking more often than usual. I'm pretty nervous at this point. I hate seeing her numbers that high before bed. Is there anything I can do to try to get them down? Her pediatrician said he'll have her retested when she's feeling better. In the meantime, I'm a nervous wreck. I'm afraid she has diabetes now and I hate to let any more time pass, but the doctor said not to test while she's sick. What do you think?

Answer:

Call your diabetes team. Sorry to say that your daughter has diabetes and your pediatrician is wrong. Sugar levels can indeed be elevated with any illness but not to 300s mg/dl [over 16.7 mmol/L]. And, with two antibody levels positive, she already has significant pancreatic inflammation ongoing. So, keep her well hydrated, check for ketones and contact your diabetes team immediately so that they can advice you about starting insulin, meal planning, blood glucose monitoring, etc.

SB