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November 28, 2004

Diagnosis and Symptoms

Question from Amarillo, Texas, USA:

I have been type 1 for 20 years, and we suspect our four year old daughter may be diabetic now. When I initially began having symptoms, I was wetting the bed, soaking everything, eventually two or three times per night. After much testing (probably only fasting glucose levels or periodic glucose serum and urine tests), my parents were told several times that I did not have diabetes. It took six years from the onset of the bed wetting for me to develop full blown DKA. Our four year old is exhibiting the same bed wetting patterns I did in the beginning, plus she is having fatigue, polyuria and polydipsia episodically. Our specialist has us testing fasting and two hour postprandial levels. Fasting levels have not gone above 110 mg/dl [6.1 mmol/L], but her postprandial levels have been as high as 185 mg/dl [10.3 mmol/L]. Periodically, she spills ketones, though we have seen no glucose in the urine. She is thin and has decreased from the 50th percentile in weight on her growth curve to the 25th percentile since May of 2004. Her antibody studies were negative, though her fasting insulin levels were slightly low, with fasting glucose level of 74 mg/dl [4.1 mmol/L](estimated pancreatic function at this time 75%). In children with this type of clinical situation, would you expect an eventual conversion to being antibody positive? Also, since this looks so much like early type 1 diabetes, despite the lack of antibodies, how long does it usually take for us to see "diabetic diagnostic levels" of fasting and or postprandial sugars? Is there any other likely differential diagnosis based on this information? We meet with the specialist tomorrow, and I expect he will recommend an herbal supplement to help maintain her pancreatic function, although I feel like this may just "buy time." Sorry for the lengthy explanation, but I am just worried that she indeed has type 1, and I don't want it to take six years and a full blown case of DKA for us to intervene.

Answer:

Perhaps unsurprisingly, there are no definitive answers here. It is quite possible that your daughter is in the pre-diabetes phase and while it would be normal to have positive antibodies in this situation, not all children have them. As for herbal remedies to maintain pancreatic function, I know of none that perform. All you can do is remain vigilant and your pediatrician may wish to see your daughter occasionally to check her urine and A1c.

KJR