November 29, 2005
Other
Question from Barnhart, Missouri, USA:
My 15 year old daughter was diagnosed with type 1 diabetes 10 months ago, six days after having back surgery for a herniated disk. At the time of her diagnosis, her A1c level was 7.1
Since her diagnosis, she has had several episodes of moderate to high ketones in her urine, but her blood sugar levels during this these episodes consistently ranged between 48 and 60 mg/dl [2.7 and 3.3 mmol/L]. The only other symptoms she exhibited during these episodes were grouchiness, fatigue, and nausea, although she never actually vomited. We have had an extremely difficult time raising her blood sugar high enough to give the additional insulin needed. Usually, we ended up spending several hours in the Emergency Room while she received glucose I.V.s to raise her blood sugar and help flush the ketones from her system.
Her endocrinologists are puzzled and have advised they have not seen this type of situation before. Her last A1c test showed a level of 4.7, with which they were very pleased. Since her diagnosis, she has lost almost 30 pounds (she was slightly overweight prior to her diagnosis), but the weight loss was not an intentional act, rather a by-product of better eating habits. She gets no exercise other than walking and physical therapy due to her diagnosis of Juvenile Disk Disorder, which has resulted in four ruptured disks in her back since her initial surgery in January.
I am desperate to find a reason for these episodes of low blood sugar/high ketones. Any guidance you could give would be greatly appreciated.
Answer:
What you describe is certainly not typical.
I hope her diagnosis of diabetes was not based solely on the A1c value, as that would not be ideal. Additionally, making the diagnosis based on a single high glucose level during a hospitalization would not be ideal either.
The presence of ketones in the face of LOW glucose also does not make any sense for someone on insulin.
I think I might suggest that you get all the records together and seek a second opinion. If your daughter is not seen by a pediatric endocrinologist, I suggest that you do so. If she is, then still seek a second opinion. In your side of state that you live, there are two excellent children’s hospitals, each with very good pediatric endocrine programs.
Something is not right here. Either there is missing information or the data are incomplete or something…..
DS
[Editor’s comment: Keep in mind that if your daughter is nauseous and not eating, she may develop starvation ketones, although these ketones usually are not “large.” These often accompany low blood sugars. See Coping with Illness. For information on blood ketone testing, see Hyperglycemia and Ketone Testing.
BH]
