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August 5, 2009

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Chicago, Illinois, USA:

My five-year-old son has been showing signs of diabetes (hunger, thirst, urination). Since my husband was diagnosed with type 1 at the age of 17, we tested our son's blood sugars two days ago and he had a reading of 167 mg/dl [9.3 mmol/L]. This alarmed us so we decided to monitor every bit of food and drink intake today. He was mostly running about 130 mg/dl [7.2 mmol/L], but, later in the evening, he had a 194 mg/dl [10.8 mmol/L] reading. We are calling to set up an appointment with his doctor first thing in the morning. I already know that his sugar should not be running this high, but are there other reasons besides type 1 for elevated blood sugar? Also, what are the chances for type 2 in children (I have heard that is on the rise)? This is very alarming because my husband and his brother have type 1 diabetes.

Answer:

Your doctor may want to see your child in the morning before your son has had anything to eat or drink. If the office hasn’t asked, you might want to anticipate this and bring him in fasted.

It is true that a number of conditions can lead to higher-than-normal blood glucoses (hyperglycemia) and are not diabetes mellitus, but such higher readings are not typically sustained over the course of a day. Certain medications can do this, too.

I have often written that just like the old parable that “not all that glitters is gold,” similarly, “not all that is hyperglycemia is diabetes — but it usually is.” This is true, especially in a five-year-old whose father and uncle have type 1 diabetes. While I hope your son does not have diabetes, he certainly remains at high risk. If follow-up with the doctor suggests this is NOT diabetes, you might still consider enrolling your child in TrialNet for children at risk.

While there is an increasing incidence of type 2 diabetes now in children, age five would still be extremely young for type 2 and such children typically are overweight. Another type of diabetes that may need to be considered is a relatively rare inherited form called “MODY.” “Routine” autoimmune type 1 diabetes is far more common.

But, first things first: get your son tested. If, before the assessment, your son begins to have nausea or vomiting or odd decreased level of consciousness, please go to the closest emergency department and contact your doctor immediately.

DS