September 11, 2003
Diagnosis and Symptoms
Question from the United Kingdom:
My wife and I took our four year old daughter to the general practitioner for some minor complaint and made the comment whilst there that she is wetting her bed on average six times a night The doctor wanted to conduct some tests on the other complaint and also took a urine sample to check if an infection would be causing the bed wetting which was negative.
We then went on holiday for two weeks, and when we returned we had a letter saying that our daughter had some disease concerning the first complaint. There was nothing mentioned about the urine. We went back to the general practitioner about the disease and again repeated that my daughter wets the bed about six times a night. She took another urine sample and put a stick in it which told her my daughter was “dry” and had “high sugar”.
We were immediately taken to the hospital where they took a blood sample and told us her sugar reading was 40 mmol/L [720 mg/dl]. I am not in anyway connected to the medical profession, but my understanding is that with blood sugar readings that high my daughter should have been in coma! On the contrary, she was running around happily and did not feel the slightest bit ill. My daughter stayed in the hospital for a few days where they said they were getting readings of mid to high teens (measured in mmol/l).
Eventually, she was discharged, and we continued to giver her daily insulin doses of Mixtard 20. The doses were initially 10 units half an hour before breakfast and 7 units half an hour before dinner. We gradually lowered the dosage and have now completely stopped the insulin. During the period we stopped the insulin, her readings were 2.7-16.7 mmol/L [49-300 mg/dl]. The high reading can easily be explained as she went to a birthday party and had some cake just before the test.
Basically, my wife and I do not believe our daughter has diabetes. She is outwardly healthy, running around, and she has been the happiest she has been in a long time since we recently stopped the insulin injections. I would appreciate your advice as to what else could be wrong with her and how it could be that if she supposedly had sugar levels of 40 mmol/L [720 mg/dl] she was still running around like any other normal four year old.
Answer:
I am sorry to say that I think that there is no doubt that your small daughter has some form of diabetes mellitus with several blood sugars over 12 mmol/L [220 mg/dl] that were carried out in a hospital laboratory. Most probably, this is type 1A (autoimmune) diabetes, but this needs to be confirmed by a series of antibody tests (e.g. anti-GAD, ICA 512, and anti-insulin. If any one of these is unequivocally positive, then you will know that she will have to take some form of insulin supplementation for the rest of her life. In addition, she should be screened at annual intervals for thyroid insufficiency and probably celiac syndrome which are related autoimmune problems.
If the tests are negative, then there are a number of other possibilities for which insulin may not always be needed, the most common of which is probably type 1B or idiopathic diabetes. You should also ask the doctor what her hemoglobin A1c was, as this might provide a confirmation that her blood sugars had been above normal for some months. The fact that she needs less insulin at the present is consistent with being in what is called the honeymoon period, and if she has occasional blood sugars of 16.7 mmol/L [300 mg/dl], she is not however insulin independent.
The fact that she seemed well while having these high blood sugars is not unusual, and she was probably not very acidotic either being really at a transition between preclinical diabetes and insulin dependence. Mixtard by the way is no longer much used in North America because being able to vary the ratio of Regular to NPH insulin seems important in children, and also of course because there has been a move increasingly to using Humalog or NovoLog just after meals with Lantus once a day in the morning or at bedtime.One last point is that if by any chance the ‘minor complaint’ concerned a possible yeast infection that would be additional support for the diagnosis.
Having said all this, I think you need help first of all from a paediatric team that looks after children with diabetes.
DOB
