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May 11, 2008

Diagnosis and Symptoms

Question from Bethlehem, Pennsylvania, USA:

My 18-month-old daughter began waking from naps shaking, I finally figured out that giving her carbohydrates (candy) was relieving the symptom and called my pediatrician. My husband was diagnosed with type 1 at age 26, which led me to think of the carbohydrates. Anyway, my daughter has also been drinking in excess and leaking through her diapers, but these symptoms alone, I figured, could have just been the diapers and typical toddler thing until the shaking. I just had a gut feeling it wasn't normal though. My pediatrician was not very concerned, but I insisted on blood work. I also did her blood sugar levels with my husband's monitor for a few days. She was running around 80 mg/dl [4.4 mmol/L] to 90 mg/dl [5.0 mmol/L] fasting and around 140 mg/dl [7.8 mmol/L] to 153 mg/dl [8.5 mmol/L] two hours after meals. We had a basic metabolic panel done and the pediatrician called and said all the results were normal and we could stop monitoring her levels and can be certain it is not diabetes. I received a copy of the results and this is what they were: Fasting Glucose: 97 mg/dl [5.4 mmol/L] - Reference Range (65 mg/dl [3.6 mmol/L] to 99 mg/dl [5.5 mmol/L]) BUN: 18 HIGH - Reference Range 3-14 Creatinine:.25 LOW Reference Range.5-1.20 BUN/Creatinine ration 72 HIGH Reference Range 6-22 Sodium140 Reference Range 135-146 Potassium 4.4 Range 3.8-5.1 Chloride 107 Range 98-110 Carbon dioxide 18 LOW Range 21-33 Calcium 10.3 Range 8.5-10.6 Although the pediatrician said it was all normal, the results clearly state abnormals in multiple areas. Is this a concern? Is it normal for an 18-month-old to have these abnormal results? A family friend that is a doctor said it could be a sign of pre-diabetes and suggested continuing monitoring and dipping her urine periodically. He also said to try to cut out excess sugar/carbohydrates and follow a consistent, healthy diet for her and that further blood work should be done to eliminate other possibilities as well. Who do I believe? My gut says there is something not right, but my pediatrician thinks I'm nuts!

Answer:

Sometimes the early stages of diabetes include a time when the pancreas does not make enough insulin and other times when it makes too much. So, one can see intermittent high and low blood glucose readings. The shakiness is definitely not normal, but you would need to “catch” the shaky symptoms and check her blood sugar at that moment. Blood glucose values below 60 mg/dl [3.3 mmol/L] would make me diagnose hypoglycemia and then the question is what is the cause. The blood work is all okay except for the low bicarbonate value that is acidotic. I would recheck that value. The BUN and creatinine values are not so unusual and not diagnostic of much of anything. If she were a little dehydrated that moment of testing, that would also cause such results.

The friendly doctor suggesting urine testing is a bit out of touch with modern monitoring since we rely much more on actual blood glucose readings rather than nonspecific urine glucose spillage. The bottom line: be vigilant. The excess urination is not normal and also suggests that there may be some hyperglycemia intermittently present. If this persists or if you remain worried, then I would schedule a consultation with a good pediatric diabetologist who can run some special antibody tests and see if any of these are positive (worrisome); they are not 100% but they will provide some other information and then you would also have someone with whom you can communicate with further questions and concerns.

SB