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May 1, 2001

Diagnosis and Symptoms

Question from Scottsdale, Arizona, USA:

My 19 year old, who has had type�1 diabetes since age six, has just had a difficult pregnancy (her diabetes was severely out of control), and the baby was delivered by C-section at 36 weeks four months ago. Because he seemed to be urinating frequently, my daughter tested his blood sugar twice. He had a fasting blood sugar in the evening of 120 mg/dl [6.7 mmol/L], and at midnight, after a feeding (he is formula-fed) his blood sugar was 157 mg/dl [8.7 mmol/L]. An emergency room visit left us with no information after four hours. Are these normal blood sugar ranges for a four month old infant? Is he developing diabetes?

Answer:

These are borderline high blood glucose values for an infant. We would probably recommend three or four days of pre and post meal monitoring as well as a baseline hemoglobin A1c to be sure this is not a true problem right now.

The family should talk to a pediatric endocrinologist familiar with very young children and get appropriate monitoring of blood glucose levels, perhaps also islet cell antibody, GAD antibody, and insulin antibody testing. If this is the beginning of diabetes, however, antibodies can be negative in the very youngest patients for reasons we do not understand. HLA risks present. Highest risks occurs during growth spurts testing may also help to see if he has specific genetic or intermittent illnesses since both of these situations are times when body needs more insulin — and thus hyperglycemia may occur. It is important to do monitoring with any unusual symptoms so that he does not become clinically ill, get dehydrated or require emergency treatment if frank hyperglycemia exists.

SB