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From Michigan, USA:

My four year old grandson was diagnosed as a borderline diabetic. He has had three fasting blood sugars between 120-130. Blood and urine tests showed ketones. He has shown all the classic symptoms of diabetes: extreme thirst, frequent urination, weight loss. His physician told his mother to keep sweets away from him, but gave him no special diet. I have had juvenile diabetes (at least that's what it used to be called-always have been insulin dependant) for 22 years. This doesn't sound right to me. I recommended that he be taken to pediatric diabetes specialist. Is this the usual treatment for this situation? His fasting blood sugars are elevated, but within normal limits. The ketones tell me he has been very high for a prolonged period. Any suggestions?


It sounds very likely that your grandson may be developing diabetes. The fasting blood sugar may be normal or only slightly elevated in the early stages. The blood sugar after eating, however, may be very elevated and if over 200, he definitely should be treated with insulin BEFORE he gets very sick. Although some 4 year olds spill ketones in the urine in the morning before breakfast with a normal blood sugar because they have gone a long time without eating and their body is breaking down fat for energy during the night, if your grandson is losing weight, most likely he is spilling ketones because he needs insulin. I would suggest he have his urine and blood sugar tested about 1 hour after a meal (with a normal to high amount of sugar in it). If over 200, he should be treated immediately. Ketoacidosis (severely uncontrolled diabetes which can be life threatening) can develop rapidly in young children. If the results of these tests are borderline, I would still suggest consultation with a pediatric endocrinologist to decide if further evaluation with blood tests to look for antibodies against the pancreas and insulin are indicated (These tests can indicate if his pancreas is already inflamed and starting to fail).


Additional comments from Dr. O'Brien:

Not everyone would agree perhaps; but to us these fasting blood sugars are not normal and we would do a two hour postprandial blood sugar and get an antibody test, especially in view of the grandmother's history.


Original posting 15 Sep 1998
Posted to Diagnosis and Symptoms


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Last Updated: Tuesday April 06, 2010 15:09:00
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