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April 30, 2002

Diagnosis and Symptoms

Question from Walnut, Illinois, USA:

When my son was recently hospitalized for dehydration with the flu, he had a blood sugar of 217 mg/dl [12.1 mmol/L] with glucose in his urine, and they told us he had diabetes, but three hours later his blood sugar was 64 mg/dl [3.6 mmol/L], and they said he didn't have it, even though he still had glucose in his urine. On the day of discharge, his blood sugar was 85 mg/dl [4.7 mmol/L], and he still had glucose in his urine with ketones. Diabetes runs in the family. Should we be concerned that my son has diabetes? Was the high blood sugar due to his dehydration?

Answer:

A random blood sugar of 217 mg/dl [12.1 mmol/L] together with glucosuria is suggestive of glucose intolerance, and the most probable cause of this in a Caucasian family would be autoimmune diabetes. In type 1A diabetes, as it is called, the destruction of the islet cells or insulin producing cells in the pancreas may progress over several years. During the ‘prediabetic’ phase (before supplementary insulin is needed), any stress such as that from an intercurrent infection can temporarily precipitate hyperglycemia and glucosuria.

To make certain if this is a possibility, especially if the family history is of this type of diabetes rather than the type 2 form, you should ask the doctor about getting an antibody test. There is an immunofluorescent screening test which is often used, but it would be much more reliable to test for the standard three antibodies: GAD 65, ICA 512, and insulin autoantibodies. If one of the tests is positive, I think it would make sense to test fasting blood sugars occasionally and certainly during any subsequent infection so as to make acute DKA [diabetic ketoacidosis] much less likely. The ketones in the urine are probably just related to a poor calorie intake related to acute illness.

If your son does turn out to have prediabetes, there is not a lot you can do at this juncture to avert the clinical phase, although a study on New Zealand schoolchildren did suggest that the vitamin nicotinamide in large doses could be of significant value and you might want to talk to the doctor about this.

DOB

[Editor’s comment: Another thought if your son has prediabetes: healthy eating, and regular exercise would be a good idea to institute. Also, home monitoring of blood sugars, especially during acute illness, might be appropriate.

WWQ]