My infant son was diagnosed with IDDM seven months ago. At that time he was in DKA. His HbA1c was 17.6. I am trying to find out what that average means. The charts I have only go up to 14.1.

Also, his pO2 levels were 30.7 to 42.3 and his O2 saturation levels were 55.9 to 74.2 over 36 hours. What does that mean? What are the dangers of these levels being low? No one explained to me what that meant. Is this normal in DKA? He was 14 months at the time of diagnosis. The doctor who attended him in the hospital said he had diabetes for at least 4 months, probably longer. For as long as I can remember he was soaking–and I do mean soaking–diapers, and the clothes, bedsheets, etc., along with it, and drinking bottle after bottle. I had no idea of the symptoms of hyperglycemia at the time. He failed to thrive and did not meet his developmental milestones.

Could you tell me please the effects undiagnosed diabetes could have on the developing brain, nervous system and over-all wellness of an infant? I am sorry to ask so many questions, but I just need some answers.

First of all, no one can tell exactly how long your child had high blood sugars before diagnosis. However, if he was saturating his diapers, most likely his blood sugar was high. The HgbA1c is a test that measures what percentage of normal red cells in the blood have sugar attached to them. There are slightly different normal levels for different laboratories, but usually about 6% is the upper limit of normal for someone without diabetes. Since a red cell only survives about 3 months in the blood before it is destroyed and a new one made, and since every day, about 1% of the red cells are destroyed and replaced, the HgbA1c reflects the average blood sugar over the past 2-3 months. The higher the blood sugar, the higher the hgbA1C. The highest hgbA1C I have ever seen is about 20%, though the upper limit of normal again varies from lab to lab. Most likely, with a value of 17%, the blood sugar was high for at least 3 months (which is unusual in young children). Usually they are symptomatic for a much shorter time before being diagnosed when they are quite sick.

It sounds like when he came in to the hospital they were monitoring the acidity (pH) of his blood. From the results of the oxygen levels [pO2 and O2 saturation] that you quoted, it might be that they were measuring the pH in blood from a vein (which is easier to get than from an artery and therefore often used in young children, although an arterial pH level is slightly more accurate). The oxygen levels in the vein are much lower than in the artery and give no reliable information about the oxygenation of the blood. When the doctor orders a pH from the lab, the lab automatically reports the oxygen information, even if it is of no use.

As far as the effect of chronically high blood sugars on brain development, I am not aware of any reports reporting delay in milestones in infants and toddlers with diabetes at diagnosis due to chronically high blood sugars, though as I said, usually parents report symptoms of only days or a few weeks prior to diagnosis.

If it hasn’t already been done, I would suggest that your child’s thyroid function be tested as an underactive thyroid is more common in children with diabetes, and an untreated underactive thyroid can cause a delay in developmental milestones in the first year or 2 of life.

TGL