March 11, 2003
Diagnosis and Symptoms
Question from Natchitoches, Louisiana, USA:
My four year old son began to drink and void a lot early in the fall so I began to take his blood sugar at home and was stunned that it was 189 mg/dl [10.5 mmol/L] one night and 186 mg/dl [10.3 mmol/L] the next. I took him to the pediatrician who says it could be prediabetes.
Since this time, he has been hospitalized four times with the same symptoms (severe abdominal pain, vomiting, dehydration). He had an appendectomy which showed mild appendicitis and mesenteric lymphadenitis with huge swollen lymph nodes in the abdomen as well as a large amount of clear fluid. He has gained no weight in the last year and a half and has lost one pound the past month.
Just last week, he suffered another episode of eight hours of severe abdominal pain, vomiting, in between which he passed out and was lethargic until the next cramping hit him. I looked over his medical records since for the last five months and found that his blood sugars are elevated each time lab work was done in the hospital (136-205 mg/dl [7.6-11.4 mmol/L] ).
We now have an appointment with a pediatric endocrinologist and pediatric gastroenterologist. What possible tests or procedures my we expect to be ordered? Should I worry about diabetes?
Answer:
Diabetes is a likely possibility to explain the higher than normal blood sugars. I agree with the plans for an evaluation by your pediatric endocrinologist. The testing for diabetes is pretty straightforward and includes blood and urine testing as well as a complete history and physical examination.
MSB
Additional comments from Stephanie Schwartz, diabetes nurse specialist:
Testing for diabetes will include blood sugar levels performed by a medical laboratory. See Classification and Diagnosis of Diabetes Guidelines for further information.
Occasionally, lab blood sugar testing might be normal in an early case of diabetes, repeat blood sugar testing at the same or a different time, or performing a glucose tolerance test, might be appropriate if there is a high suspicion of diabetes despite normal initial testing. Another test, the glycosylated hemoglobin, might be used to help confirm a suspected diagnosis of diabetes, but the GHB (also called HbA1c or A1c) is not usually considered as appropriate to make an initial diagnosis. Antibody testing is occasionally done as a screening test in high-risk situations, or as confirmatory of type type 1A (autoimmune) diabetes, but is not part of routine testing.
SS