March 18, 2004
Diagnosis and Symptoms, Hyperglycemia and DKA
Question from Richmond, Virginia, USA:
In the past two months, our two and a half year old daughter has been admitted to the emergency room for blood sugar issues. Both were affiliated with illness. The first episode was for dehydration due to a stomach virus. When she got to the emergency room, her blood glucose was 41 mg/dl [2.2 mmol/L]. Within two to three hours and an apple juice, her blood glucose was 495 mg/dl [27.5 mmol/L]. After the first episode, she was diagnosed with type 1 diabetes, but it was retracted after she maintained good levels on her own with minimal insulin intervention. The second episode was from vomiting attributed to strep throat. She was very lethargic after vomiting, so I tested her blood glucose and it was 370 mg/dl [20.5 mmol/L] within minutes after vomiting. In the emergency room, she pepped up, and her blood glucose was 98 mg/dl [.5 mmol/L] when tested.
The pediatric endocrinologist is attributing both incidences to stress-hyperglycemia. Do you think she will “outgrow” this or, if she is destined to have dramatic blood glucose fluctuations with every illness, or if she is likely pre-onset type 1? Could you please give me some background on the diagnosis of stress hyperglycemia and why it seems to be repeating?
Answer:
“Stress” certainly is a normal stimulus to lead to higher glucose readings. When stressed, we need energy, for instance, as fuel to run away if frightened. We make increased amounts of various hormones, such as cortisol and adrenaline, when stressed and these hormones, along with other mechanisms, help us to release stored glucose into the blood.
Glucose levels into the 300s (mg/dl) [over 16.7 mmol/L] seem a little high to me for simple “stress.” It may be that the child does have glucose intolerance and has diminished insulin producing capacity and may indeed have risk of type 1 diabetes.
Please talk with your doctor and the pediatric endocrinologist about consideration of pancreatic antibody testing for type 1 diabetes. I do not usually advocate formal glucose tolerance testing, but a properly prepared and performed glucose tolerance test may be warranted here, based on your description.
DS
