October 15, 2003
Diagnosis and Symptoms
Question from Leesburg, Virginia, USA:
My three year old son has type 1 diabetes diagnosed six months ago, and a couple of weeks ago, I pricked my five year old daughter’s finger for no reason while she was sleeping. Her blood sugar was 350 mg/dl [19.4 mmol/L] so we checked her in the morning, and her blood sugar was 80 mg/dl [4.4 mmol/L]. So of course I panicked. I called the doctor, we took her in, and her urine test were fine.
A couple of days later, I checked her at home, and the urine stick turned brown so again I called, and we took her back into the doctor. It turned brown there also indicating glucose in her urine, and her blood sugar was 203 mg/dl [11.3 mmol/L]. The doctor told us she had type 1 diabetes and we went to the endocrinologist.
A hemoglobin A1c there was 6.1% (upper limit of normal), and a fingerstick blood sugar was 93 mg/dl [5.2 mmol/L]. The doctor ordered an antibody test which was negative, and a two hour after meal blood sugar was 199 mg/dl [11.1 mmol/L]. They told me to come in a week, which I did. My daughter is thinking she has diabetes now and is completely stressed out I know. She knows what it is because she sees her brother dealing with it everyday. Anyway, they have not done anything to her yet.
Even though they told me she doesn’t have it yet, I’m continuing to check blood sugars a couple of times per day for the next couple of weeks. Her fasting blood sugars every morning are under 120 mg/dl [6.7 mmol/L], the ones after her meals really vary from normal to above normal, and I’ve only had one reading of 248 mg/dl [13.8 mmol/L] on the meter that was bad. Could this be a stress response to high blood sugar? Do you suspect I probably caught it early, and the antibodies have not shown up yet?
I’m really reluctant to treat her because she has never had one sign of diabetes at all, and I know what to look for because my son went through it. She does have a cold right now, but I don’t think that should affect her blood sugar. How do we really know though when we don’t check the normal population every day? I know they check people in hospitals, but how else do they come with up 200 mg/dl [11. mmol/L] being the limit for blood sugars?
We did just move into a new house about a month ago, with new schools (kindergarten) and new friends, etc. Could stress rise your blood sugar for a period of time Some days she has normal sugars all day, and other days, she doesn’t. My daughter is very nervous little girl. Everything makes her nervous from having a different bus driver to the bee at the bus stop. I don’t know. She might just be stressed all the time.
I’m just wondering how many children walk around like her and maybe their bodies correct themselves and they don’t get any worse. If I never checked her that night I would know nothing else. She could have been like this for a while. Does that happen? Do we not know because we don’t walk around pricking children and sticking urine sticks under them? Do you think it could be years before she is diagnosed or does the process usually happen over a couple months? Might she never get any worse?
I just hate to start treating her knowing in the back of my mind that maybe she is just stressed or maybe she won’t ever get any worse. Maybe she won’t get it for five more years. No one can tell me for sure what will happen to her body personally, but maybe I should just watch her closely and wait for signs. Do you think the next time she gets sick that will start the wheels in motion? Is there another test they can do to see if she is at risk to get it (I thought I heard there was) since the antibodies were negative? Is it unhealthy for her to walk around like this? She is eating fine, acting fine, etc.
I learned a hard lesson. Don’t prick your child’s finger unless you see signs. I personally would rather wait until she has it then wonder every day when she is going to get it. I hate the honeymoon phase anyway. It’s much harder to handle. My son’s is much easier to predict now that I know the honeymoon phase is over.
Answer:
It may be difficult to know about a second child getting diabetes but knowing that this is a possibility or that a child has positive antibodies or intermittent hyperglycemia means that she will likely not get very sick, develop DKA [diabetic ketoacidosis], get dehydrated, or need a hospital stay. Antibody testing is only positive about 60-80% of the time depending upon the exact lab and exact assay being utilized. Sometimes antibody tests are negative and then become positive later on.
It may also be helpful for you to discuss this with a social worker or psychologist who works closely with your child’s diabetes team so that they can help you realize that you did not do anything wrong by checking her blood glucose readings and finding abnormalities. At the moment, your feeling guilty is very normal but not very helpful for you or the rest of your family. In fact, it is probably a good thing for you to be aware that your child has several high blood glucose readings.
Exactly how she is to be treated at this very early stage is difficult to advise but should be discussed very directly with your child’s diabetes team. They can let you know how often she should be getting blood glucose levels checked, whether or not you should modify her meal plan and cut back on concentrated sugars, etc. When to start insulin treatment is difficult to determine with some diabetes specialists recommending early treatment to rest damaged beta cells and others waiting for more consistent blood glucose elevation before starting insulin. Nobody really knows the best answer at the moment. Of course, should she begin having more consistent high blood glucose levels, and should she start urinating excessively or drinking excessively or have ketones with these high blood glucose levels, this would mean that insulin deficiency is no longer intermittent and likely that insulin injections will be needed.
SB
