May 16, 2012
Diagnosis and Symptoms
Question from Fresno, California, USA:
For several months, my four-year-old son was experiencing an urgency to urinate, sometimes as frequently as minutes apart, but more often about half an hour apart. I took him to the pediatrician who did a urine dip for a UTI and it was negative. He did not mention any other results and diagnosed my son with bladder spasms from too much citrus. I cut back my son’s citrus and the problem continued. I also noticed that he began to get up at night to urinate at least twice and once he wet the bed (he has been dry for over a year). I took him back to the pediatrician who tested his urine for glucose and it was +2. The pricked his finger an hour later and he had a blood glucose level of 118 mg/dl [6.6 mmol/L]. It had been approximately three hours since he had eaten some carrots. He has lost 2 pounds in the last year. His pediatrician referred him to an endocrinologist. The next day, at the endocrinologist’s office, his blood sugar (on a meter) was 112 mg/dl [6.2 mmol/L] (two hours after half a piece of toast) and his A1c was 5.1. The next morning, we did an informal glucose tolerance. His fasting blood glucose, on a meter, was 92 mg/dl [5.1 mmol/L] and he then ate two pancakes covered in maple syrup and a large glass of juice. At one hour, his level was 211 mg/dl [11.7 mmol/L]. At two hours, his level was 132 mg/dl [7.3 mmol/L]. We are waiting for results on antibodies and other tests. I know his laboratory fasting glucose number was 90 mg/dl [5.0 mmol/L] and his insulin was “low,” also fasting. Other pertinent information is that he has dark circles under his eyes and when he used to nap, he would wake up daily shaking an trembling and sort of out of it after a three or more hour nap. He often falls asleep in the car if we drive for any length of time in the afternoon. Does this sound like early type 1? His pediatrician believes his pancreas is still working, but that he will eventually need insulin. His endocrinologist seems to agree, although she is more hopeful that he might not be diabetic.
Answer:
Unfortunately, it sounds like early phase diabetes where the pancreas beta cells which make insulin are beginning to fail.A normal blood glucose should be in the 70 to 100 mg/dl [3.9 to 5.6 mmol/L] range before eating and rarely go above 126 to 140 mg/dl [7.0 to 7.8 mmol/L] after eating. So, the values you report are clearly not normal. If there were simultaneous insulin levels drawn and they were low at the same time there was high glucose then this would suggest insulin deficiency, of course. Antibodies would be positive about 40 to 60% of the time in this age group. If positive, this would confirm typical – but early – type 1 diabetes and insulin would be likely started. With a meal plan and early insulin, there is some research suggesting that this can save pancreas function and make for more stability for along period of time – a good goal. It sounds like your pediatric endocrinologist is doing all the proper testing. If you notice changes in symptoms, ongoing weight loss, increased urination or enuresis, then call their office. Watching the glucose levels will obviously also let you know what is going on so that you do not have to be guessing while you wait for other test results to return. Excellent that you went to get consultation early enough so that your child can get monitored and diagnosed.
SB
