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May 15, 2002

Diagnosis and Symptoms

Question from the USA:

Two weeks ago, my four year old daughter (50th percentile weight, 90th percentile height) had a blood sugar of 359 mg/dl [19.4 mmol/L] during a yearly pediatric visit, and was sent immediately to an endocrinologist with a diagnosis of diabetes. She had/has no outward symptoms (no thirst, frequent urination, etc.). She tested negative for ketones and her antibody test was also negative, adn we have no known of diabetes in our families. We've tested her blood glucose four times a day (before meals and at bedtime) for the past 18 days and her average blood glucose is 95 mg/dl [5.2 mmol/L] in the morning, 144 mg/dl [8 mmol/L] at lunch, 168 mg/dl [9.3 mmol/L] at dinner, and 181 mg/dl [10.1 mmol/L] at bedtime with no insulin. We've changed to a low carb/healthy diet and no other signs of illness or infection are present. We have an excellent diabetes team who (after preparing us for ttwo weeks that this is a very early honeymoon phase of Type 1 diabetes) is now telling us that it is very likely that we simply caught the progression to type 1 diabetes very early, but it could possibly be a virus or some other unknown environmental factor that has inflamed her pancreas and might move on. We'll continue to monitor her blood glucose over the next few months and see where it goes. I'm simply curious if anyone has seen a case similar to our daughter's and if so, what was the outcome?


I find your daughter’s case extremely interesting for a variety of reasons. The main reason is that our own practice has seen two or three similar stories in the past several weeks. No doubt, I have seen several children with diabetes who presented this way and “caught” very early. It has always turned out to be an atypical presentation of type 1 diabetes, but I suppose the other considerations brought up by your endocrinologist cannot be forgotten. Last year, I saw a patient with encephalitis due to an enterovirus present with what was initially thought to be type 1, but he actually was overweight and had type 2. Enteroviruses have been postulated in the past to be linked to type 1.

The issue is not merely academic for your daughter but almost moot. Regardless, the common thread is a degree of glucose intolerance mandating special attention with details of activity, meal planning, etc.