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May 16, 2002

Daily Care

Question from South San Francisco, California, USA:

My three year old son, diagnosed at the age of 22 months, has had hemoglobin A1cs of 6-7% over the past year, but since catching gastroenteritis two months ago, his blood sugars have been high and low, and have never returned to normal. Lately, he's been having ketones when he wakes up in the morning. One night, his reading at 9:00 pm was at 98 mg/dl [5.4 mmol/L], he had a 1 carb snack, at 11:00 pm he was 165 mg/dl [9.1 mmol/L], at 2:00 am he was 133 mg/dl [7.4 mmol/L], and then he woke up at 8:00 am with a blood sugar of 165 mg/dl [9.1 mmol/L] but a serum ketone level of 0.9. On another night, before his 9:00 pm bedtime, he was 94 mg/dl [5.2 mmol/L], and he had his snack. Then at 11:00 pm, he was 131 mg/dl [7.3 mmol/L], at 3:00 am he was 76 mg/dl [4.2 mmol/L] so I gave 2 ounces of milk, at 6:00 am he was 219 mg/dl [12.2 mmol/L], and then he woke up at 266 mg/dl [14.5 mmol/L] with a serum ketone level of 0.4. Any idea what's going on? Why is he so susceptible to ketones all of a sudden when previously his sugar could go as high as 500 mg/dl [27.8 mmol/L] without ketones?

Answer:

There could be some damage to residual pancreatic function from the virus or merely less insulin being produced and some ongoing normal growth that allows this to show up. It’s hard to know for sure.

You should ask these questions of your son’s diabetes team since they know your child well. You should also be checking some overnight blood glucose readings to be sure you are not missing any nocturnal hypoglycemia which can sometimes cause morning ketones to be positive.

Has anyone checked for celiac disease with a test called transglutaminase antibody?

SB