May 8, 2012
Diagnosis and Symptoms
Question from Stanwood, Washington, USA:
My five-year-old daughter has been suffering a lot of really bad headaches recently, so bad that I took her to Emergency Room thinking something was really wrong. That is when everything changed! They sent her home saying it was a migraine. The next morning, when she woke, she was really sweaty and shaky so I called my mother-in-law, who is a nurse practitioner, and who said might be low sugar, to test her. I didn’t think to much about it but gave her some juice then she was fine. Later that day, we ate dinner and I decided to test her post meal just to see and her sugar was 189 mg/dl [10.5 mmol/L]. After that, I started keeping track fasting, two hours post meal and before bed. Her fasting sugars were 70 to 114 mg/dl [3.9 to 6.3 mmol/L]; her post meal sugars have been anywhere from 133 to 193 mg/dl [7.4 to 10.7 mmol/L]; and bedtime sugars are always on the low end of 78 to 83 mg/dl [4.3 to 4.6 mmol/L]. I talked with the doctor and he decided to do an A1c and urine; both were normal. Her A1c was 5.4. I am not sure what is going. Two hours after breakfast, my daughter’s sugar was 177 mg/dl [9.8 mmol/L] so I gave her some protein to take it back down and it went to 140 mg/dl 7.8 mmol/L] and off to school she went. I got a call three hours later saying she was flushed, dizzy and had a tummy ache so I went to get her and her sugar was 64 mg/dl [3.6 mmol/L]. She does drink a lot and always seems to be snacking on something or hungry and seems to go potty at least 8 to 12 times a day and at least once in night. Should I be worried it is diabetes? If so, what do I need to do since her blood work has all been normal? And, what type would she be? She is not overweight but type 2 does run on both sides. My husband and I do not have it but grandparents do.
The numbers you describe are definitely not normal. While the symptoms sound like it could be hypoglycemia, the blood glucose readings do not confirm this. It could be she is sensing the change from high to low. Overall, there were too many intermittent high blood glucose levels so this could be an early form of diabetes where the pancreas is beginning to die out and stop working, not making enough insulin enough of the time. She may need some pancreas antibody tests and likely should have a consultation with your local pediatric endocrinologist to sort this out. If you notice increased urination, night urination, enuresis or unexplained weight loss, those are all signals that perhaps there are more consistent high blood glucose levels and something has changed – this would demand more urgent evaluation…perhaps.