June 14, 2001
Diagnosis and Symptoms
Question from Berkeley, California, USA:
My husband has had type�1 diabetes since age seven, and recently I felt our two and half year old had sinusitis so I took her to her doctor. He didn’t think it looked like an obvious case and wanted to try her on an antihistamine/decongestant for a few days. That same day (before starting medication), I checked her glucose with my husband’s meter and it read 204 mg/dl [11.3 mmol/L] and then 196 mg/dl [11mmol/L] an hour and a half after eating. I ran a control on the meter and it was in range.
I called the doctor who wasn’t too alarmed and said we should wait for her to get well to discuss further testing. Since then, she has tested 180 mg/dl [10 mmol/L] on one occasion, and upon waking was 128 mg/dl [7.1 mmol/L] on one meter and 83 mg/dl [4.6 mmol/L] on a different brand of meter. She has also had normal glucose readings on both meters, and her urine has been negative for ketones and glucose. She did not improve on the medication and is now on day five of amoxicillin for presumed sinusitis and has shown some improvement.
What should I do next? I know the meters have a certain degree of error inherit in them. I am worried sick that she is showing some impairment of glucose tolerance and may develop diabetes in the future.
I understand there is news from a large clinical trial to be released at the end of this month that may show that low dose insulin can delay onset of the disease. I feel it would be helpful to have her tested for the antibodies and the genetic markers as well as fasting plasma glucose and/or glucose tolerance. Should I take her to see a pediatric endocrinologist?
Answer:
Considering the circumstances, I think that it makes good sense to arrange an antibody test for your daughter. If this is negative, it would not be necessary to complete the other tests like HLA typing. You should call 1-800-425-8361 to find the nearest center for the National DPT-1 She is still too young (less than three) to actually participate in the oral insulin trial, but not too young for further testing if the antibody test is positive.
DOB
[Editor’s comment: Children under the age of three often do not have antibodies. In addition, it is not unusual for children this age to have high blood sugars during an illness, usually due to dehydration.
Having said that, because of your husband’s history of type�1 diabetes, I would check some fingerstick blood sugars once your daughter has been over her sinusitis for about a week. It would be particularly prudent to check them in a fasting state as well as about two hours after a high carb meal (such as pancakes with syrup, etc.). If you are still finding that she has elevated blood sugars, even intermittently, and/ or she begins to display symptoms of diabetes, I think that a referral to a pediatric endocrinologist might be in order.
SS]
