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June 1, 2000

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Michigan, USA:

When my 5-year-old daughter has had a fever recently, her blood sugar levels shoot up to 280 to 300, she spills sugar (500 - 1000) in her urine, and has moderate ketones in her urine. She also has stomach pain. The doctor has usually ruled as a viral infection. She was brought to the ER and admitted one time and said to have stress-induced hyperglycemia. At that time, they didn't think she had diabetes. That was the first time that happened. She has had other episodes since then and the blood levels go back to normal once the fever or illness ends. My husband has type 1 diabetes and is on insulin twice a day, so when my daughter gets sick we monitor her now--and yes our meter is checked and working right. I also monitor her once or twice a month with a ketone dipstick that monitors the sugar also. It's always normal unless she's sick. Any ideas why, when she gets sick, her levels go haywire and where can I find information on cases like hers? Can this turn into diabetes? She has a twin brother who shows no symptoms of this.

Answer:

Autoimmune or Type�1A diabetes is the commonest form of this disorder in Caucasian children in North America. It is also a condition in which the destruction of the insulin producing cells is very gradual indeed so that it is not uncommon in the later stages for the stress of intercurrent infections to induce a temporary glucose intolerance. It seems almost certain that your daughter has the same kind of diabetes as her father and the best way to confirm this would be to ask her doctor to arrange for an antibody test. A number to call for more information is 1-800-425-8361: depending on the result and on your wishes she might be a candidate to participate in a national trial [the DPT-1 study] of small doses of insulin to see if this will delay the onset of permanent insulin dependence.

DOB