March 4, 2004
Diagnosis and Symptoms, Other Illnesses
Question from Fort Worth, Texas, USA:
One month ago my 10-year old very healthy daughter and I had a terrible virus. We had identical symptoms, fatigue, nausea, thirst. After having this one week, my daughter started vomiting. I took her to her pediatrician. Her blood sugar was high, around 290 mg/dl [16.1 mmol/L], so he sent us to the emergency room. They immediately diagnosed her with type 1 diabetes and admitted her. At 4:00 a.m. she started having terrible pain in the upper left quadrant of her abdomen. They thought she was having a heart attack. Her lipase was 200. Four hours later it was 407. They diagnosed her with pancreatitis, but never “undiagnosed” her with diabetes. She is on NPH and Humalog insulins. Her pancreas is healing and they have reduced the insulin substantially. Of course, they attribute this to the “honeymoon phase”.
There is not one case of diabetes in either my husband’s family or my family. The endocrinologist assures me this had been coming on for months and I just haven’t noticed it. My daughter is an only child. When she is not at school she is with me. She went snow boarding at Christmas and just won her school spelling bee. I truly believe she was healthy as a horse until we got this virus, which I believe attacked her pancreas and threw her blood sugars completely out of whack.
I also wonder, if I had not taken her to her pediatrician that morning, but rather to the emergency room at 4:00 a.m. when she was in excruciating pain, whether a diabetes diagnosis would have ever been made, since they could see the reasoning for the high blood sugar. What do you think? Is there a definitive way to determine what this actually is?
Answer:
It sounds like fairly typical new onset type 1 diabetes. Almost always there is no family history since this is a random event in a genetically susceptible individual with common susceptibility genes. It is good that you took her to the doctor since she would have gotten considerably more ill with a delay in fluids and insulin management. Often there is concomitant pancreatitis. It is possible that this is only pancreatitis, but usually insulin production isn’t so damaged with an acute bout of pancreatitis. And, 10 year olds virtually never have heart attacks, so you may have misunderstood what the doctor’s concern was, or they were responding only to the discomfort level and merely speculating out loud. In any case, islet cell and GAD65 antibodies may be checked and, if positive, would place her in the typical peripubertal type of type 1 diabetes onset; however, such antibodies are only positive in about 60-80 percent of kids so they are not helpful if negative. Time will surely also tell you what to do since you respond to blood glucose levels no matter what the cause. Stay in touch with your diabetes team and they should help figure this out over the next few months. Don’t be afraid to ask them questions and insist that they explain things so that you can understand their thinking.
SB
