Question from the Republic of Ireland:

My seven year old white son (54 pounds) has had three periods of frequent urination, thirst, and elevated blood sugars which always drop down to normal, but has not been diagnosed with diabetes yet. He is never ill although but can be rather grumpy when the sugars are high. There is no history of diabetes in the family.

His first episode was 10 months ago, when he was on a high dose steroids for his asthma (He is currently taking a low dose of Becotide preventer). He was admitted to hospital with an initial blood sugar levels of 24 mmol/L [432 mg/dl] which stayed for a week. His blood sugar levels reduced to normal as he was taken off the steroids, and steroid use was given as the cause, although it was said he may be more susceptible.

One month ago, he started drinking again and had high blood sugars (around 20 mmol/L [ 360 mg/dl]. He was admitted to hospital for monitoring and the sugars dropped again to 10 mmol/L [180 mg/dl] by the morning. He was then discharged with the reason for his high sugars unknown ! At this time he also had some blood in his urine.

Last week, his sugars and A1c were normal. He still had some blood in his urine and may be referred to kidney specialist in six to eight weeks. Since this latest test, his sugars have fluctuated (10-22 mmol/L [mg/dl]), and we are due to see an endocrinologist in 10 days.

Any explanation be given for these fluctuations? Can he be producing insulin now and again, or is his insulin being blocked, or are his alpha cells producing massive amounts for some reason? What tests should be carried out to determine whether he really is in need of insulin? I am very reluctant to start him injecting 2-3 times a day if he does not need it as he has a phobia about needles, and this would be his worst nightmare.