September 13, 2001
Diagnosis and Symptoms
Question from Muncie, Indiana, USA:
My four year old son has polydipsia, polyuria, and is losing weight. (We presumed because he is no longer on Pediasure, as he was for over two years.) He recently had surgery and became really agitated about 20 hours after his last food/drink. I asked the nurse to check his blood sugar (in case he was hypoglycemic from fasting so long), and his blood sugar was 174 mg/dl [9.7 mmol/L]. He had an IV of potassium in normal saline running at the time. Could this be due to the pain or should I be concerned about diabetes?
A fasting blood sugar of 174 mg/dl [9.7 mmol/L] is certainly abnormal, but in a four year old, it could indeed be due to pain or the stress of hospitalisation so it does need to be repeated. I assume too that the drip was indeed normal saline and not a saline dextrose mixture. In doing this, it would be important to minimise the stress of sampling either by using a device like the FreeStyle meter or by arranging for a nurse or technician to take the sample who is used to doing this in small children and who could use a very small needle sometimes called a “butterfly.”
Assuming that further fasting blood glucoses possibly aided by other tests like blood hemoglobin A1c or serum insulin levels confirm a diagnosis of diabetes, the next step is to determine the cause. In some respects, this might not be all that important because the treatment of all forms of diabetes is to achieve and maintain normal blood glucose levels in the simplest manner possible. However, in your son’s case, it does seem possible that the diabetes and the need for Pediasure might be due to an agenesis of the pancreas which includes both endocrine and exocrine components, i.e., both insulin production and the making of digestive enzymes The latter component would account for what I assume was a chronic failure to thrive. Another possibility it that malnutrition for some other reason might have caused the diabetes.
You need to discuss all this with the doctors including the possibility that your son might indeed have type�1A (autoimmune) diabetes, which would need to be confirmed by an antibody test.