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May 16, 2006

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from California, USA:

My three and a half year old daughter recently had an OGTT done in-patient with an endocrinology specialty clinic. She weighs 34 pounds and was given 29 grams of carbohydrate to drink. The doctors have confirmed her results to be abnormal but, honestly, do not know why. She continues to have symptoms of nausea, fatigue, intermittent frequent urination, thirst, and bed wetting. Home monitoring gives us a blood sugar range of 58 to 190 mg/dl [3.2 to 10.6 mmol/L]. She is very symptomatic under 72 mg/dl [4.0 mmol/L] with non-responsiveness, twitching, fast heart rate, hunger, irritability and sleepiness. Her results are as follows: Time Blood Glucose Insulin Level Ketone Level Lactic Acid Level Fasting 88 mg/dl [4.9 mmol/L] 1.1 uIU/ml 3.12 mg/dl 2.2 mmol/L 30 minutes 107 mg/dl [5.9 mmol/L] 6.0 uIU/ml unknown 1.1 mmol/L One Hour 130 mg/dl [7.2 mmol/L] 12.0 uIU/ml 1.04 mg/dl 1.0 mmol/L 90 Minutes 95 mg/dl [5.3 mmol/L] 6.9 uIU/ml .52 mg/dl 1.1 mmol/L Two Hours 85 mg/dl [4.7 mmol/L] <2 uIU/ml .83 mg/dl .9 mmol/L Three Hours 96 mg/dl [5.3 mmol/L] 3.1 uIU/ml .73 mg/dl .9 mmol/L Four Hours 74 mg/dl [4.1 mmol/L] <2 uIU/ml 6.86 mg/dl .7 mmol/L Five Hours 72 mg/dl [4.0 mmol/L] <2 uIU/ml 12.17mg/dl 1.0 mmol/L At three and a half hours, she was very symptomatic and her blood sugar was 68 mg/dl [3.8 mmol/L]. When they did the four hour testing, the also measured her cortisol as 4.7 ug/dl and her growth hormone as 2.8 ng/ml. She also had clinically low alanine and ornithine on her amino acid panel. She is scheduled to see a metabolic specialist in June but continues to have problems and no one seems to be able to help her. She is now taking raw cornstarch at night and before preschool, per the metabolic department, until she can be seen. What is your opinion on the blood ketones rising after the three and a half hour mark? Are her insulin levels normal throughout this test? How about the cortisol and growth hormone during her "crash;" should they be higher? Why does she NOT recover? Does this sound like a pre-diabetic condition? She is negative to all antibody testing thus far.

Answer:

This certainly isn’t diabetes, but it is interesting that she began the day with ketones. I wonder if she doesn’t have a true metabolic problem. A referral to the specialist seems totally reasonable. There are forms of ketotic hypoglycemia. It is beyond the discussion here and really difficult to diagnose in this forum. Make sure you keep that appointment with the metabolic specialist.

LD