December 20, 2005
Diagnosis and Symptoms, Hyperglycemia and DKA
Question from Jackson, Ohio, USA:
My 10 year old son has had high glucose levels for months, but his A1c tests are always in the normal range. The endocrinologist thought maybe he was in the honeymoon stages of type 1 diabetes until he wore the sensor and it showed no evidence of it. His fasting levels are always higher than the normal range. Also, when he sleeps his levels don’t fall down in the lower levels, according to the sensor readings, either. He has spiked a lot of readings in the 300 and 400 mg/dl [16.7 and 22.2 mmol/L] levels, but no ketones.
He spiked a high of 341 mg/dl [18.9 mmol/L] when he wore the sensor, but it did not show up on the sensor, Instead, there was a blank space in the line. But, when he spikes the highs, they go back down without any intervention. He also has a lot of the other symptoms of diabetes such as the increased thirst, frequent urination, nausea, and headaches. He also turns very pale and complains about being very hot, even though he doesn’t have a fever. The endocrinologist said that he has a high glucose tolerance. They call him a mystery boy because all the symptoms of diabetes are there, but it doesn’t show up in the tests. When he had a fasting glucose tolerance test, his blood sugar was low, 65 mg/dl [3.6 mmol/L].
My son has days that he can eat anything and it doesn’t seem to bother him. His glucose readings are normal. Then, there are days that he seems like no matter how carefully he eats and counts carbohydrates, he spikes highs. He has a lot of allergies for which he takes injections. He also has frequent ear infections, almost monthly in the fall and winter months.
I would appreciate any information you could give me. We have been trying to figure out this for about a year now and seem no closer to any answers now than when we began.
Answer:
This situation sounds very unusual. I assume that you have had negative islet cell, insulin and GAD65 antibody tests. Has he been tested for celiac disease? Is there any other evidence of autonomic nervous systems dysfunction? I wonder if your endocrinologist has presented him to other colleagues to solicit other opinions. If not, perhaps a second opinion from a second pediatric endocrinologist would be in order. Be sure to take all the laboratory information that you have already collected so that it does not need to be repeated. Time may help you figure out what to do. If there is deterioration of blood glucose levels, i.e., during an illness, then things may change. If there are only intermittent blood glucose spikes which then self-correct, this may merely represent a “faulty thermostat” and no insulin may be needed unless such abnormalities persist and can be documented.
SB
