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November 4, 1999

Aches and Pains

Question from Sudbury, Ontario, Canada:

My son is 10 years old and has had diabetes for 2�1/2 years. He was recently diagnosed with strep throat. The illness began with a head cold (plugged runny nose for one day) followed by a sore throat (one day). On the third day, he appeared to be better, but about 9:30 a.m., He developed a sore stomach and vomited. Everything was better until mid afternoon, when he began to vomit bile. He was taken to hospital early evening, was admitted and put on IV fluids to rehydrate him. His glucose numbers on day 1 and 2 were a little high, but his levels have always been erratic. On the third day, his numbers went out of sight, and he started passing ketones. It was rudely suggested that he had developed the illness because his glucose was not being properly managed. Is it possible for a child's immune system to be harmed by erratic numbers running up into the teens [13 mmol/l equals 234 mg/dl], to the point that he could contract disease (strep) more easily than if his numbers were kept in the 6 to 8 mmol/l range [108 to 144 mg/dl]?

Answer:

Although high blood sugars can predispose to some infections, most children with reasonable control are not more prone to the usual childhood infectious ailments such as strep throat. It is my experience, however, that strep infections can raise the blood sugar very high and very rapidly and cause the child to spill ketones very rapidly, even if the child is not very sick from the strep infection itself. Strep infection can also cause abdominal pain and vomiting (as can ketones). I usually recommend that if a child has abdominal symptoms with high blood sugars and ketones for more than a day, that a throat culture be taken even if the child is not complaining of a sore throat. These culture turn out to be positive fairly often and treatment with antibiotics usually results in fairly rapid improvement of both the high blood sugars and abdominal symptoms.

TGL