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July 18, 2016

Diagnosis and Symptoms

Question from Sellersburg, Indiana, USA:

My nine-year-old daughter was tested for type 1 three weeks ago. She had been seen in the Emergency Room three times in the course of three months for kidney infections. All three times, her blood sugar was elevated - 139 mg/dl [7.7 mmol/L], 160 mg/dl [8.9 mmol/L], and 162 mg/dl [9 mmol/L]. On two of those occasions, she had glucose in her urine. Her blood sugar was checked in the doctor's office the following week and was 132 mg/dl [7.3 mmol/L], no glucose in her urine. She had blood work done; her A1c was 5.1 and antibodies were normal. I had been checking her a few times a day prior to the laboratory results and, for a week, her blood sugars ranged from 125 mg/dl [6.9 mmol/L] to 170 mg/dl [9.5 mmol/L]. Then, for two days, she was normal so the doctor said to stop testing after the laboratory work was good. She hadn't been eating well at all during these checks, borderline fasting. She has had a few of the symptoms for a little while, wanting water all the time, not overly thirsty though, wetting the bed a lot, very lethargic, hungry....all the time, and is very very moody. She has celiac also that was diagnosed last year. I checked her morning blood sugar level yesterday because she was really not feeling well and threw up once before bed. It was 119 mg/dl [6.6 mmol/L]. Is it possible that the infection was so bad in the hospital that is caused her sugars to be off? Is there any reason why she would have glucose in ther urine, infection or otherwise? Is it possible for her laboratory results to be normal and have normal sugar levels and still be in the early stages of type 1?

Answer:

Those are puzzling results, but definitely not normal blood sugar levels. Antibodies are not always positive, just most of the time, when type 1 diabetes is diagnosed. I would disagree with not testing her sugar levels since this only means you do not have more needed information and wouldn’t then know if the levels got worse or stayed the same. The values you describe are borderline high values but really not completely normal. I would recommend that the A1c test be rechecked in 3 to 6 weeks and periodically thereafter to make sure it does not rise. Also, I would recommend a consultation with a pediatric diabetes specialist who can give some more individualized recommendations. Make sure she is getting plenty of extra water with extra salt (sugar free drinks, for instance) so that if the high sugars are causing the enuresis and the urinary tract infection as well as extra thirst, she won’t get dehydrated. I would also recommend monitoring her weight at least daily for a while since weight loss that is ongoing also would be worrisome that high sugar levels were the cause. If there is sudden, unexplained nausea, vomiting, abdominal pains or weight loss with these symptoms, then contact your doctor urgently or take her to the emergency room for re-evaluation.

SB