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March 16, 2016

Diagnosis and Symptoms

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Question from Las Vegas, Nevada, USA:

My five-year-old daughter was taken to the ER for high fever, joint pain, headaches, fatigue, and thirst. She was diagnosed with type B flu and had sugar in her urine. Her glucose reading was 308 mg/dl [17.1 mmol/L]. After dehydration was treated I.V., her glucose dropped to 295 mg/dl [16.4 mmol/L] about 1 hour later. She was given a shot of long acting insulin and, since then, she has had glucose readings between 64 mg/dl [3.6 mmol/L] and 154 mg/dl [8/6 mmol/L]. She was hospitalized for five days because she was having a hard time fighting the flu. I have an appointment with the endocrinologist in two weeks to receive the results of blood test. The pediatrician thinks that she does have type 1 diabetes and that she is in the honeymoon phase. Can someone go into the honeymoon phase after only one insulin treatment? Or, do you think that the high blood sugar was a one time event caused by the flu virus? My pediatrician also told me today that based on her other blood test, she does appear to be having problems with her thyroid as well (TSH Ultrasensitive 0.17 8 mc intl units/mL “LOW”). Can both things be related?

Answer:

From: DTeam Staff

The flu could have been the “trigger” for new diabetes since any such type of infection sometimes requires more insulin. If a person has diabetes, new or already diagnosed, then they may become symptomatic from the higher sugar levels.

Also, one injection of insulin does not “cure” new diabetes nor does it induce a honeymoon. I assume that the tests that were ordered were an insulin blood level at the same time that the initial blood glucose level was 308 mg/dl [17.1 mmol/L] and very high. That would provide information about the pancreas ability to produce insulin. By definition, with such a high level, the pancreas was insufficient/not working.

Then the next question, is whether or not there are positive antibodies. We can measure four of them: islet cell, IA2, GAD65 and ZnT8. Any positive are abnormal and say that there is pancreatic inflammation and this is associated with type 1 diabetes. About 20% of patients are negative for such antibodies and still have type 1 diabetes – so this testing is not definitive but helpful.

If you are not seeing the pediatric diabetes team for a while, it is important to keep checking blood glucose levels so that you will know if your child is having normal or abnormal blood glucose values and be in touch with your regular doctors. If there are symptoms of excess urination, excess thirst, bedwetting or ongoing weight loss, these are likely related to high sugar levels and your child cannot wait for the consultation.

SB