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November 19, 2005

Diagnosis and Symptoms

Question from Florence, Alabama, USA:

I checked my four year old granddaughter's blood sugar after I noticed that her cheeks were bright red. Her blood sugar was 212 mg/dl [11.8 mmol/L]. This was about one hour after a breakfast of cereal, toast, and juice. I waited an hour and checked it again. This time, the reading was 138 mg/dl [7.7 mmol/L]. I also checked it again about four hours later and the reading was 108 mg/dl [6.0 mmol/L]. Is this normal? She's going through a stage of being hungry a lot. Type 1 and 2 diabetes runs in the family. Should we be concerned?

Answer:

It is unusual for very young children to have diabetes. But, it can happen. If you are noticing other signs, such as excessive thirst, weight loss, or frequent urination, it would be wise have your granddaughter’s physician do further testing. Diagnosing diabetes requires a laboratory test of blood glucose.

BS
Additional comments from Dr. Tessa Lebinger:

I agree that any child with a blood sugar of 200 should be evaluated by a physician even if the child is asymptomatic. I’ve seem many asymptomatic children picked up with early diabetes at their routine yearly physical with sugar in the urine. Usually the first abnormality is an elevated blood sugar after eating (fasting blood sugar may be normal for a longer time).

I agree that the diagnosis should not be made by a meter reading, but confirmed by laboratory testing. Very rarely children with a virus or other illness with have a documented elevated blood sugar hat does not to progress to true diabetes. It is also not uncommon as the pancreas is failing to have normal blood sugars when the child is well, but intermittently high blood sugars when the child has a virus or other illness and temporarily needs to make more insulin. I usually recommend if the initial laboratory evaluation is normal, that the child test the urine for sugar at least once a day for a while (preferably after the largest meal of the day) and several times a day if the child is sick. If sugar appears in the urine, the child should be evaluated before symptoms appear, and immediately if the child is sick as ketoacidosis may develop in a few hours if the child is sick with a virus or other illness. Most two year olds are not diagnosed until they present very sick with ketoacidosis. It is much preferable to diagnose the diabetes in the early stage and avoid potentially life threatening ketoacidosis.

Testing for antibodies that are associated with type 1 diabetes might be helpful. I think it is misleading to say diabetes is rare in a two year old. That may give false reassurance to the family that they don’t have to further evaluate this high blood sugar obtained by a meter.

TGL