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August 27, 2018

Diagnosis and Symptoms

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Question from Indiana, USA:

My daughter will be 4 in October. Two years ago, she was ill with a high fever and lethargy. I checked her blood sugar and it was 178 mg/dl [9.9 mmol/L]. I took her to an urgent care where her blood sugar was measured as 175 mg/dl [9.7 mmol/L] and they catheterized her. Because she was spilling glucose and ketones, they sent us to the Emergency Room (ER). I thought we were on the way to a diabetes diagnosis. The ER gave her fluids and ran blood tests; they got her back to 127 mg/dl [7.1 mmol/L] after two bags of fluids. They said her blood work was normal and to follow up with regular doctor. We did and they did an in office A1c that was 5, so they advised me to check random blood sugars and let them know if anything were to change. She has always consumed a lot of fluids. The illness passed and we went about our lives.

Over the past 4 months, she has been telling us constantly that her head and belly hurt. She is peeing constantly, but I haven’t caught any ketones. Bedwetting has resumed. Her moods are erratic, her breath smells fruity, and her urine smells sweet. She sweats in bed. Last night, at 5:30 p.m., she had about 2 ounces of barbecue sausage, five corn kernels and one mini gold potato. At 7:30, she had a handful, maybe 5 to 10, of Cheezits and an italian ice popcicle. At 8, she drank 9 ounces of 2% milk with 1 teaspoon of sugar-free Nesquick powder. Her blood sugar at 8:45 p.m. was 142 mg/dl [7.9 mmol/L]. I just don’t know where to go with everything tetering back and forth. Her father has Crohn’s disease, too, and I’ve read where she has a higher chance of developing an autoimmune disorder because of that. I tried to check her fasting blood sugar this morning but she was completely uncooperative. What are your thoughts on my daughter’s situation?

Answer:

The blood glucose levels you report are definitely not super high but also definitely not normal. So, diabetes remains a possibility, could be early onset type 1 (autoimmune) diabetes mellitus or could be some variant like MODY. The symptoms are also suspicious for diabetes, too. I would suggest that you contact Dr. Linda DiMeglio or one of her colleagues at the Riley Children’s Hospital Diabetes Unit in Indianapolis for consultation and they can do some more antibody and genetic testing to try to help sort this out. If symptoms change or worsen or if there is any weight loss or vomiting, then please go to the Riley Emergency Room and they can provide more urgent evaluation and contact the diabetes team as well.

SB

[Editor’s comment: See Monogenic Diabetes (Neonatal Diabetes Mellitus & MODY) for more information on MODY.

BH]