November 15, 2016
Diagnosis and Symptoms, Hyperglycemia and DKA
Question from Owosso, Michigan, USA:
I have been questioning my son’s sugar levels because he has symptoms. Dad is diabetic and I had gestational diabetes. My son goes through a box of 80 diapers every two weeks, drinks constantly, and wants sugar. I have been monitoring everything he eats and doing meter tests in the morning and evening. I have been getting highs and lows and the numbers seem to bounce, from 80 mg/dl [4/5 mmol/L] at night to 135 mg/dl [7.5 mmol/L] at wake up at or 110 mg/dl [5.5 mmol/] at night, with 70s mg/dl [3.9 to 4.4 mmol/L] at wake up. Once, he was 260 mg/dl [14.5 mmol/L], but I think he was teething and was sleeping; two hours later, he was down to 92 mg/dl [5.1 mmol/L]. One other time, his fasting blood sugar was 180 mg/dl [10 mmol/L]. Blood work was done recently, non-fasting, resulting in an A1c of 4.9, C-Peptide of 1.9, and insulin level of 7.5. I was told it was normal. So, what are the are normal ranges of C-Peptide and insulin for a 20-month-old? And, why are the glucose numbers bouncing so dramatically? I was told I could let up on the monitoring but I am terrified that if I do, it’s going to go way out of control. I’m just learning the signs of the highs–he gets really hyper and does not listen. Should I continue to watch his sugar? When should I worry?
These are very unusual results and you are correct that this could be very early diabetes. Certainly, intermittent high glucose levels like this are not normal. The A1c and C-Peptide results are reassuring but you may want a formal consultation with a pediatric diabetes specialist and especially may want specific diabetes related antibodies ( IAA, ICA, GAD-65, ZnT8) to be checked and measured. If positive, this would indicate higher risk of developing overt diabetes; if negative, it would be somewhat reassuring but such antibodies are not always positive, so somewhat inconclusive. I would agree with you that ongoing monitoring will help you know if something changes and certainly avoid his developing diabetic ketoacidosis (DKA). There also are some research studies ongoing that might help with genetic testing for risks of his developing diabetes too. Keep an eye on his hydration and make sure weight loss is not occurring associated with higher sugar levels, excessive urination/thirst since those are the key objective abnormalities.
In addition to the symptoms he is now having, if he were to develop “fruity” breath, this would be an indication of ketones, possibly DKA; you would need to take him to an Emergency Room as soon as possible, preferably at a Children’s Hospital, and insist on testing for type 1 diabetes. With respect to research studies, you should consider enrolling your son in Trial Net.