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November 30, 2003

Diagnosis and Symptoms

Question from Vancouver, Washington, USA:

My two year old son Max had been suddenly been drinking tons of fluid, urinating all the time and showing extreme irritability. Max was given a blood glucose and urine glucose test at the pediatrician's office. Urine was negative, blood glucose was 184 mg/dl [10.2 mmol/l]. We were sent home and asked to preform a three day log with a home blood glucose monitor. Max ranged from 82-281 mg/dl [4.5-15.6 mmol/l]. He was then admitted into the hospital. They did many tests, most are still pending. His A1c was normal. He has only been symptomatic for about two weeks. Would that account for the normal A1c? At home we were asked to continue monitoring. He fluctuates a lot, anywhere from 82-351 mg/dl [4.5-19.4 mmol/l]. Is this normal? The endocrinologist said that this does not fit the typical onset pattern for type 1 diabetes yet it is possible this is the early stages. He said that that the pancreas was tired and would let the blood sugar get high for a couple of hours, then it would drop him down to a low normal range. He then said if we were to start insulin, Max would have a hard time controlling hypoglycemia. We seem to be seeing a slow but steady increase in blood sugar, where the highs are getting higher. So far the urine has been negative for ketones and glucose which makes no sense to me. We are positive the monitor is working well. I would greatly appreciate another opinion.

Answer:

From the information you provided, I would agree with the endocrinologist’s explanation. Sounds like this could be the very early start of diabetes. Keep up the monitoring and let the endocrinology/diabetes team know if there are persistent high values, symptoms change, etc. If antibody tests were done and if they are positive, this would make further progression very likely with the need for insulin in the coming months. Often such antibody tests can also be negative even when diabetes will develop and may need to be rechecked sequentially. Staying away from simple sugary drinks and foods may also help preserve pancreas function. You can see if this matters with your BG monitoring.

SB