June 16, 2005
Diagnosis and Symptoms
Question from Truckee, California, USA:
My 14 year old daughter has had type 1 for two years, so, when my 18 month old starting drinking excessively (80 to 90 ounces a day) and wetting 10 or more diapers a day we got concerned and tested her with my daughter’s meter. She has had readings from 81 to 285 mg/dl [4.5 to 15.8 mmol/L]. We have tested her at least 20 times over the last week or two. Our pediatrician and endocrinologist wanted to admit our daughter, but she has NO physical symptoms, aside from excessive thirst and urination, and has a A1c of 5.6. We have at least one reading a day in excess of 225 mg/dl [12.5 mmol/L], many in the low to mid 100s mg/dl [5.6 to 7.5 mmol/L], and the rest normal.
Before I subject an 18 month old to shots and an insulin regimen, I want to rule out other possible causes for the blood glucose levels and thirst. Ironically, my 14 year old daughter is biological, but our baby was adopted from Russia last summer and carries no biological connection. It seems impossible to have this happen again, especially to my baby who was randomly matched to us out of 400,000 possible children. Unfortunately, Russia has no family history about the mother or father except that the mother was 24 years old and “healthy” when she gave birth. The birth father was “unknown”. My 18 month old was tested for AIDS, sickle cell, etc. when she came home and was healthy as a horse. She consistently gains a bit of weight, is on the small size (mother was petite supposedly) and is developmentally perfect. Please let me know what else can cause blood glucose levels to be high beyond diabetes. Is there any chance it can be type 2 or is it always type 1 in otherwise healthy babies?
Answer:
Wow! What a story!
First of all, I think that it is very likely that your precious 18 month old indeed has type 1 diabetes. She certainly (apparently) fulfills diagnostic criteria, Classification and Diagnosis of Diabetes: she has increased thirst, increased urination, and elevated glucose readings.
As I commonly say: “just as ‘not all that glitters is gold,’ not all that is hyperglycemia is diabetes, but it usually is.” There are not too many conditions, in a non-overgrown, developmentally normal, otherwise normal toddler that can lead to the changes in urination and thirst and elevated glucose, except, probably diabetes.
The fact that the A1c is not high thus likely indicates that you have “caught” this early. Remember, the A1c is NOT a diagnostic test for diabetes, but rather a test for overall glucose control over the preceding two to three months. I would not necessarily diagnose diabetes based on fingerstick glucose values with a glucometer or at least I would want an elevated glucose confirmed with a true serum glucose from a venipuncture.
If I were the doctor, I, too, would want to admit the 18 months for confirmation before submitting to the lifelong consideration of insulin injections. Sorry, but I would not think it likely at all in this age child for this to be type 2 diabetes.
There is no consistent scientific evidence for environmental “triggers” to cause type 1 diabetes, yet your family’s situation is certainly compelling. Talk with your pediatric endocrinologist.
DS
