January 26, 2004
Diagnosis and Symptoms
Question from Fort Meade, Maryland, USA:
My five year old daughter has been complaining of headaches for approximately six weeks. In addition, she has been complaining of generally “not feeling good.” Recently, she seemed very thirsty and tired. My six year old was diagnosed with Type 1 Diabetes when she was four years old, so in order to put my mind at ease, I checked my five year old’s blood sugar. The result was 307 mg/dl [17 mmol/L]. My pediatrician sent us to the ER.
Her blood sugar in the ER was down to 99 mg/dl [5.5 mmol/L]. They did a CT scan to rule out any underlying cause for the headaches, and that was clean. They sent us home checking her blood sugar several times a day for the last three days. Generally, it has been in normal range, with the exception of one morning fasting level of 138 mg/dl [7.7 mmol/L], and one pre-meal level of 156 mg/dl [8.7 mmol/L]. No ketones at all. We are awaiting the anti-bodies tests as well as an A1C.
Is it possible that this is the very beginning stages of Type 1 diabetes, and we just have caught it extremely early? In which case, how long does it take for the disease to fully present itself once the blood sugars become slightly unstable? Are there any other explanations of an elevated blood sugar that high in a child with no signs of infection or fever? What are the percentages of siblings of a type 1 diabetic developing the disease when there is no other family history of the disease?
Answer:
A blood sugar level of 307 mg/dl followed shortly after by a normal one of 99 mg/dl is most probably a stress effect and a random blood sugar of 156 mg/dl is also within normal limits. The fasting blood sugar of 138 mg/dl is a little high; but in the circumstances I think it could also be a stress effect. Nonetheless it was sensible in view of the family history to order antibody tests and an A1c level. If the former are all negative that would rule out the commonest Type 1A or Autoimmune form and likewise a normal A1c test would also tend to rule out the much less common antibody negative forms of Type 1 Diabetes. There are other causes of elevated blood sugars; but they are again rare and usually accompanied by characteristic physical signs and the blood sugar rises are constant.
The preclinical form of Type 1A Diabetes can occur for many years before insulin dependance shows; but the antibody tests are positive. Finally the chances of a second child developing this form of diabetes in a situation where there is no other family history is about 1:20.
DOB
