My daughter smells like sweet fruit punch. She sweats this odor and her mouth smells like this. She had her blood sugar checked and it was 77 mg/dl [4.3 mmol/L]. The doctor said this was normal and left. This was her reading after eating a Toaster Strudel at 7:30, a popsicle at 8:30, and chicken at 10 a.m. They checked her blood sugar at 10:45 a.m. She complains about her head hurting and always feeling sick to her stomach. Wouldn’t eating prior to the test be enough to make her reading higher than 77 mg/dl [4.3 mmol/L]?

I presume that the blood test in question was a serum glucose level. I will also assume that it was drawn from a vein and not a “fingerstick” done on a tiny meter with a value given in less than a minute.

One must interpret medical tests in light of the clinical situation. In your child’s case, the “fruity” smell apparently made your physician concerned about ELEVATED glucose levels. The glucose was not elevated. Thus, the child (very probably) does not have diabetes mellitus. But, diabetes mellitus is usually associated with increased thirst and urination anyway, so, the history is not very suggestive of diabetes to me anyway.

The headache and stomach issues are not typical of diabetes either. But, both of these symptoms AND the “fruity” smell may be associated with increased body concentrations of a series of chemicals called “ketones.” Ketones may also be elevated in forms of acutely poorly controlled diabetes. But, other things can lead to ketones. Ketones can be tested in the blood or, even more easily, in the urine. But, they are not there “all the time” so it is best to test for them during a CURRENT episode of headache PLUS stomach issues PLUS the “fruitiness.”

Keep an open dialogue with your healthcare team. Most forms of increased ketones are not worrisome. Some forms can be very serious, but, in broad terms, those worrisome issues are associated with developmental and growth issues.

DS