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August 22, 2001

Diagnosis and Symptoms

Question from Orlando, Florida, USA:

My 16 month old child has an inherited metabolic condition that diabetes is quite common in, has just started on a very small dose of insulin, and so far, her highest blood sugar has been 191 mg/dl [10.6 mmol/L]. Her doctors are still uncertain as to the type of diabetes she has and have even considered the possibility that her high blood glucose may be a result of a virus in her pancreas. My questions are: If this is just a virus, will the tiny dose of insulin cause her to become hypoglycemic so we will know that she doesn't need it anymore? If her hyperglycemia is indeed being caused by a virus of some sort would there be any symptoms? This child used to suffer from episodic hypoglycemia during illness and extended fasting, is this something often seen as a precursor to diabetes? We just feel like we want to know if she does indeed have diabetes or if viruses causing hyperglycemia are common and usually require insulin. Finally, her numbers are still high after breakfast before the insulin kicks in, and we don't want to give it to her too soon before she wakes up because we don't want her sugar too low. How do you manage that? Is it harmful to have high readings for and hour or so before the insulin starts to work?

Answer:

It would have been a help to have known exactly what the metabolic condition is because that might well determine the exact nature of the diabetes. For instance, in a rare mitochondrial disorder called MELAS syndrome, the diabetes is due to a disorder in energy production which especially affects the insulin producing cells, but it can sometimes require very little insulin as in your child’s case.

The likelihood of a viral cause is really very small although there have been very occasional reports of Coxsackie viruses being responsible. This is an effect distinct from the way an acute viral illness can quite often be the final stress that triggers insulin dependence in the late stages of autoimmune pre-diabetes.

A viral infection that actually caused the diabetes would not necessarily produce symptoms.

The earlier hypoglycemic episodes sound like ketotic hypoglycemia, a relatively common and temporary condition in small children which is due to carbohydrate deprivation and the consequent dependence on fat stores for energy.

Finally you might consider discussing with the doctor changing the intermediate insulin to a new product called Lantus (insulin glargine). It gives a very even release over the 24 hours which would allow the remaining beta cells to respond to after meal peaks.

DOB