April 27, 2007
Diagnosis and Symptoms
Question from Maryville, Tennessee, USA:
My five-year-old daughter was sent to the Emergency Room (ER) Tuesday morning because her blood sugar was 272 mg/dl [15.1 mmol/L] at the pediatrician’s office. It dropped to 192 mg/dl [10/7 mmol/L], then to 124 mg/dl [6.9 mmol/L] within a couple of hours. She was admitted for observation. The highest blood sugar after that was 149 mg/dl [8.3 mmol/L] 90 minutes after eating. Her hemoglobin A1c level was 4. All pancreatic and kidney function was normal. We are continuing to monitor her levels, but the endocrinologist is still not sure. We are waiting on the antibody tests to come back next week. The endocrinologist said it could be stress induced hyperglycemia, but the pediatrician thinks her initial level was too high for that to be the cause. Does this make sense?
Answer:
Newly diagnosed diabetes, especially if caught “early” sometimes shows up like this. Antibody tests will be confirmatory if positive; if negative, they won’t help. Antibody tests, however, are only positive in 60 to 80% of newly diagnosed type 1 children/teens so there are 20 to 40% false negatives. Close monitoring of blood glucose readings would be prudent as would a restriction of simple carbohydrates meal plan. Stress (i.e., viruses, other infections, etc.) also can do what you have described. If the A1c is elevated, then there has been more significant hyperglycemia for a longer period of time; if this were a new phenomenon, then the A1c could also be normal. Time often will help figure out exactly what is going on and how to treat so that frequent blood glucose monitoring will be invaluable.
SB
