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September 16, 2004

Diagnosis and Symptoms, Honeymoon

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Question from Banning, California, USA:

I took my four year old daughter to the doctor for what I thought was a bladder infection. She had been frequently wetting and had pain when urinating, abdominal pain, and vomiting. The doctor told me she had diabetes, that her pancreas was failing and to take her to the hospital. At the doctor’s office her blood sugar was 319 mg/dl [17.7 mmol/L] with large ketones in her urine. Once in the ER her blood sugars were still high, but, after being there for quite some time, her blood sugar dropped to 37 mg/dl [2.1 mmol/L]. When I was repeatedly asked if my daughter had been given insulin at the doctor’s office, I told them no, they hadn’t given her anything. It was difficult to arouse her and they gave her an i.v. with an injection of glucose.

The day after being admitted into the Intensive Care Unit (ICU), my daughter was given four units of Lantus for two successive nights. Then, her Lantus was dropped to two units for two nights, then zero units. The rest of the days in the hospital, her sugars never went below 69 mg/dl [3.8 mmol/L] and never over 180 mg/dl [10.0 mmol/L]. They had wanted her to be in the 80 to 180 mg/dl [4.4 to 10.0 mmol/L] range. She was then treated for a bacterial infection.

We were frequently told by the physician and other doctors that she is in the honeymoon stage and to enjoy it while it lasts. She had many tests done while in the hospital and, being so new to this disease, I don’t recall what they were or what they meant. Since she has been home, I’ve been monitoring her blood sugars four times a day with nothing under 69 mg/dl [3.8 mmol/L] and nothing over 168 [9.3 mmol/L]. She has been back to the endocrinologist and had a glucose tolerance test done; we’ve yet to learn the results. She goes back in three months. They aren’t sure if she has type 1 diabetes. Now, I am to monitor her before and after meals twice a day. I am very concerned and extremely confused. What is going on?

Answer:

From: DTeam Staff

Your questions are valid. And, if it is any consolation, I’d wager that your physicians are not certain either. That is why they performed many tests, including the glucose tolerance test.

You’ve heard that “not all that glitters is gold”? Well not all that is high blood glucose is diabetes. But with the combination of very elevated glucose such as your daughter had, with the concurrent presence of ketones, I’d have diagnosed her with diabetes. The sudden “dropping” out of glucoses makes no sense.

Is she on any treatment plan now? Is she taking any medications? Are there any meal planning or restrictions? This might be an early and profound honeymoon, but I don’t think it would be classic. Maybe your daughter actually had a bout of pancreatitis?

I think you should discuss the results of the oral glucose tolerance test; I don’t think you should have to wait three months to learn those results. Ask your Diabetes Team if they measured pancreatic antibodies on your daughter.

DS