July 16, 2005
Diagnosis and Symptoms
Question from Caldwell, Idaho, USA:
My two-year-old son was diagnosed with celiac disease in October 2004. We have a strong history of type 1 and other autoimmune disorders on both my side and my husband’s side of the family. Because my son’s blood sugar levels are consistently between 100 and 200 mg/dl [5.6 and 11.1 mmol/L] and he displays off-and-on symptoms of diabetes, including excessive thirst and urination, and extreme mood swings, his pediatrician referred him to an endocrinologist in April 2005. The endocrinologist told us to cut sugar out of his diet, occasionally check and record his blood sugar, and call if he went over 200 mg/dl [11.1 mmol/L]. His blood sugar usually stays around 150 mg/dl [8.3 mmol/L], but more and more often he spikes to anywhere between 250 and 450 mg/dl [13.9 and 25 mmol/L]. He always comes down on his own within just a few hours. Just as I was instructed, I call every time.
These increases concern me very much, particularly because they effect him so much (in terms of mood and behavior) and are happening more frequently than they used to. His endocrinologist is unconcerned and says there is nothing we can do at this point. Isn’t there something that can be done to keep his blood sugar more stable? I would appreciate any advice. I am thinking of getting another doctor who will take my concerns more seriously. Is that necessary? Do I need a second opinion or do you agree with my son’s endocrinologist?
Answer:
Your son’s blood sugars are clearly abnormal if they go above 200 mg/dl [11.1 mmol/L]. Please see Classification and Diagnosis of Diabetes for the current guidelines on diagnosing diabetes. There is additional testing that your son may benefit from if he clearly is having high blood sugars. If he has diabetes, he obviously would benefit from insulin therapy to help normalize the blood sugars.
Diagnosing diabetes can be very difficult in the very early stages when informed parents pick up on sometimes subtle signs. Occasionally, a course of watchful waiting is in order, but if he is having blood sugars above 200 mg/dl [11.1 mmol/L] that can be confirmed in a laboratory, he likely will require insulin as soon as possible. I would review your concerns with both your pediatrician and your endocrinologist.
MSB
