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October 14, 2005

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Sachse, Texas, USA:

I have a 12 year old with type 1, diagnosed at the age of two. Recently, his brother who at five, is tall and very skinny, was not feeling well and I noticed that his breath smelled fruity. I checked his blood sugar out of curiosity and it was right at 200 mg/dl [11.1 mmol/L] and he had large ketones. I made sure the meter was coded right and also checked my own blood sugar. All he had eaten the few hours before was a sugar-free jelly only sandwich. Later, upon rechecking, he was 180 mg/dl [10.0 mmol/L]. I freaked out thinking about two kids with diabetes and called the doctor. When seen, the doctor told me he "looked fine" and had no glucose in his urine and that he could not explain the readings. I insisted on an A1c test and it was great, 4 something. He had a second episode of being sick with an elevated sugar of 170 mg/dl [9.4 mmol/L]. The doctor told me to check his urine for glucose, stop the glucometer readings and only worry if he has sugar in his urine, which is fine, but I still have lingering fears. Is this normal for children when they are sick? Should I have some antibody test I saw mentioned on this web site? Is this a precursor to developing diabetes? I welcome any information to put my mind at ease.

Answer:

It is important to monitor any sibling of a child with diabetes closely. I would suggest that the best way to monitor is to watch carefully for symptoms of diabetes, including excessive thirst, excessive hunger, dramatic weight loss and frequent urination. When any combination of those symptoms are present, screening for diabetes using urine testing at home or, more accurately, with a blood test done at your physician’s office would be helpful. There is some evidence that screening for some antibodies that are associated with type 1 diabetes could help predict risk of diabetes, but I would not suggest using that testing at this point. Perhaps we’ll have a better way of predicting who might be at risk for diabetes and actually being able to prevent it, in the future. In the meantime, careful watch for symptoms and early treatment is likely the best strategy for a sibling of a child or teen with diabetes.

MSB