October 13, 2007
Diagnosis and Symptoms, Hyperglycemia and DKA
Question from Cedartown, Georgia, USA:
Back in March, a good friend of mine had a child diagnosed with type 2 pre-diabetes. This was all new information to us and her meter was a new toy. We decided to check all of our children, mainly out of curiosity. My daughter, three at the time, got a reading of 530 mg/dl [29.4 mmol/L]. We were confused, but decided that the machine wasn’t made for little children. Two months later, at her first endocrinologist appointment, they were reading through the meter and saw the number. The doctor said that I definitely needed to follow up with this reading.
That evening, I took my daughter over to have her checked by the same meter and got 374 mg/dl [20.8 mmol/L]. I was concerned, but she showed no symptoms at all. Her fasting the next morning was 169 mg/dl [9.4 mmol/L], so I called the pediatrician. She was very concerned and told me to pack a bag, that we were probably going to spend some time in the hospital. However, when we got to the office, my daughter’s reading was only 89 mg/dl [4.9 mmol/L]. They saw her again the next morning and her fasting was only 78 mg/dl [4.3 mmol/L]. The A1c came back in the high normal range. So, they just dismissed it as nothing. They had already told me that the home units are pretty accurate, but now I am confused. I checked her at home for another week after this and got no abnormal readings, so I quit sticking her.
Well, today, my middle child has been drinking huge amounts of water so I got the machine down to check him, just to be careful. His reading was only 124 mg/dl [6.9 mmol/L]. I checked my daughter’s blood sugar while I had the meter out and it was 354 mg/dl [19.7 mmol/L]. So, I washed her other hand and rechecked within two minutes and got 214 mg/dl [11.9 mmol/L]. This was taken right before she started eating a bowl of cereal I had already fixed, so I took it again after her snack (30 minutes later) and got 224 mg/dl [12.4 mmol/L]. However, one hour after her snack, her blood sugar was down to 114 mg/dl [6.3 mmol/L]. My own blood sugar was 95 mg/dl [5.3 mmol/L] so I feel like it was pretty accurate.
I am sorry that this is so lengthy, but I am very confused about what or who to see. I asked for the endocrinologist referral months ago. What are the chances of readings this high, that far apart, and randomly taken? Also, are there other things that could cause such crazy numbers? And, in order for ketones to show up in the urine, would it need to be taken soon after a high reading? No one has been able to give me an answer so far. She also has frequent UTIs, thirst, tummy aches, and seems to crave sugar, but what four-year-old doesn’t? Any direction would be greatly appreciated. I am just very confused and concerned.
Answer:
You have the perfect right to be confused with some of these numbers. But, you also have the perfect right to be a little worried.
I cannot tell you that the child has diabetes mellitus. Please see the many, many questions about the Diagnosis and Symptoms and information about the Classification and Diagnosis of Diabetes on this web site to help DEFINE under what circumstances diabetes mellitus can be diagnosed.
I don’t know what glucose meter you use, but I would absolutely double check the meter and strip “codes” – if you have that type of meter. I would suggest you use a major manufacturer’s glucose meters, rather than a “store-brand.”
Have further discussion with your child’s pediatrician and make sure a good history, looking for symptoms, and a physical exam, looking for signs, are performed. Might your child benefit from a consultation with a pediatric endocrinologist? Maybe. Might a challenge test, such as a properly performed glucose tolerance, be required? Maybe.
There are many EXCELLENT pediatric endocrinologists, some at the academic centers and also in private practice, in the large metropolitan area 60 minutes from your hometown.
DS
[Editor’s comment: You probably need not worry about checking for ketones if your child does not have diabetes. In a person with diabetes, ketones usually indicate the lack of insulin and are to be checked when blood sugars are over 240 mg/dl [13.3 mmol/L] or when the child is ill. For further information, see our page on Hyperglycemia and Ketones Testing. Keep in mind that a person who does not have diabetes can test positive for ketones as a result of diet or sickness.
BH]
