December 23, 2017
Diagnosis and Symptoms, Hyperglycemia and DKA
Question from Elba, Alabama, USA:
My five-year-old daughter has been on a sugar limited diet since the age of three with the help of a food clinic rehabilitation center that determined sugar to be the main issue. So, we eliminated many sugars, both natural and artificial, from her diet. This last year, a friend suggested that my daughter might have diabetes. Since then, I’ve checked her sugars semi regularly and noticed that when they are low, in the 70s mg/dl [3.9 to 4.4 mmol/L] she gets lethargic and ill, and just wants to sleep. One day she had a bad day at school and came home and just wanted to go to sleep. I could tell she didn’t look well so I checked her blood sugar immediately. Her sugar level was 205 mg/l [11.4 mmol/L]. I was unsure what to do when all she wanted to do was sleep. I checked her twice to make sure I didn’t get a bad strip or some other issue. Even using alcohol and re-checking on another finger, it still read 205 mg/dl [11.4 mmol/L]. After sleeping some, her blood sugar was then about 130 or so [7.3 mmol/L]. I’ve taken her to three different doctors, all of whom were not concerned with the blood sugar numbers, including the 205 mg/dl [11.4 mmol/L]. I’m convinced something is going on. She always shows signs of problems. The doctors will not refer her to an emdocrologist and I don’t know what else to do. Are these levels acceptable for a child her age? The doctors won’t listen to me because her A1c comes back in acceptable ranges, they say, but we, for the most part, control it via diet. I’m sure that if she were on an actual regular diet she would have overly high readings all the time but I’m so afraid to try it myself. Please help.
Answer:
Sorry for all the problems you are having getting a referral, but a pediatric endocrinologist/diabetologist is who you need to see in consultation. The blood sugar readings in the 70s mg/dl [3.9 to 4.4mml/L] are normal so this is not the cause of her symptoms. However, the random higher blood sugars in the 200 mg/dl [11.1 mmol/L] range are distinctly abnormal/too high. She may have what we commonly call prediabetes where the high blood sugars occur intermittently, especially if you are limiting carbohydrate intake already, which may be partially treating this situation. She may need more specific testing, insulin levels, a formal glucose tolerance test and pancreatic/diabetes antibody testing to see if any of these are normal or abnormal and to get more specific dietary advice. Other conditions such as pituitary, thyroid and adrenal disturbances, as well as celiac disease, also can sometimes cause such nonspecific symptoms and intermittent blood glucose abnormalities and need to be checked out as well. Please go back to your primary caregivers and insist that a formal consultation be set up to try to solve these problems. If she suddenly shows other signs of more persistent high sugar levels: enuresis, excess daytime urination, excess thirst, increased fatigue or unexplained weight loss, these are signs that the high sugars may no longer be only intermittent and need more immediate/urgent attention.
SB
