July 29, 2006
Diagnosis and Symptoms
Question from Cleveland, Tennessee, USA:
My eight year old daughter has many health problems, such as arthritis and eosinophilic enteritis that make it hard to distinguish the cause of her symptoms. Almost two years ago, she lost over 10 pounds and has not gained much back since. Last fall, her pediatrician noticed that she had fallen of her growth chart for weight and height. Her height is 48.5 inches at eight years, 10 months of age. We have been seeing an endocrinologist since. She is always tired, gets up every the night to drink at least once, and many nights she gets up multiple times and gets up at least once, if not more, to go to the bathroom.
In June, she underwent a growth hormone stim test. Her results came back normal, but the endocrinologist noticed that her glucose dropped to the 40s mg/dl [2.2 to 2.7 mmol/L] 60 minutes and 90 minutes after glucagon was administered. He told me to check her sugars at home, every morning before eating and anytime she had symptoms. He rechecked her levels and checked her potassium and insulin level. Her glucose and insulin were normal, but her potassium was elevated. Her potassium remained high at subsequent tests over the past six weeks. The endocrinologist also checked her cortisol, which was normal and her aldosterone and renin, which came back elevated. On a recheck last week, all her laboratory tests were normal. On the other hand, her sugar levels that I have been checking at home have not been normal. Her fastings over the past three weeks have been normal most of the time, but, on at least five occasions, her levels have been over 100m g/dl [5.6 mmol/L], the highest being 139 mg/dl [7.7 mmol/L]. Also, her random sugars have been high even more often. On at least eight different occasions, her sugars have been over 126 mg/dL [7.0 mmol/L], up to 199 [11.1 mmol/L]. Once, it was much higher than that. On this occasion, something extremely weird happened. She had been complaining of being tired and was sweating a lot. It was hot out, but we were in the house and you could see sweat on her upper lips. Her behavior was a bit out of control and she was drinking a lot. When I tested her glucose, it was 408 mg/dl [22.7 mmol/L] but, when I rechecked 30 minutes later, it was only 68 mg/dl [3.8 mmol/L]. I checked the machine in between the tests to see if there was something wrong, but it showed that it was working correctly. I have checked other family members with the meter and I am pretty sure it is working accurately since everyone else had consistently normal sugar results on this meter.
My daughter is going to have fasting and urine tests at the pediatrician’s in a two days and I am concerned that since her glucose levels aren’t consistently high, the blood test will come back normal even though something is wrong. We know there is something wrong with my daughter. We just don’t know what and I am concerned about her lack of growth and other symptoms.
Is it possible that my daughter could have diabetes even if she doesn’t have high sugars every day? Can you have diabetes if your insulin blood test results are normal? If you have diabetes, do you have high glucose readings every day? If her fasting comes back normal, is that definitive that she doesn’t have a problem with diabetes at this time?
The blood glucose values you report are definitely not normal. However, with such intermittent abnormalities, this could be an early phase of diabetes where the pancreas is partially working – but erratically. It could also be other problems such as an autonomic neuropathy, gastrointestinal “dumping syndrome” or a mitochondrial disorder. You should ask if these things have been considered, especially since they are extremely difficult to diagnose. A genetics or metabolism expert may be able to assist in evaluating for such extremely rare and intermittent disorders. Sometimes staying away from simple, concentrated sugars is helpful so this can be tried since there is not much that you, as parents, can do.