Could this be early diabetes?

[Lamky]

We have a referral to a pediatric endocrinologist for our 2 (almost 3) year old son. His symptoms are concerning me in the mean time and I'm not sure how to best manage them.

It all started a few weeks ago pretty suddenly. He had intermittent abdominal pain throughout one night and I assumed it was due to constipation. In the morning, I was on hold with the pediatricians office when I looked over at him and he had appeared to pass out. After managing to arouse him just a little, I ended up calling 911. It turns out his glucose was only 40 and he had an elevated white blood count (27,000). He was admitted and evaluated for intessuption (sp? he didn't have it) and given glucose. After one bag he was only up to 53. Two bags 65. He was on maintenance IV after that. 36 hours later the "diagnosis" was constipation. Glucose was normal as was his WBC. Which never made sense to me (or the wonderful resident on our case), but the attending kept saying I just must not have noticed he had a decreased appetite for a long time (Believe me, I would have noticed!) At this point no one asked for a Ped Endo consult (had I know to ask, I would have).

A week later our pediatrician did a fasting glucose (85), a BMP and an insulin test. We just got the insulin test back and it was only 1.6, which I understand to be well below normal. Our doctor said this would be seen in diabetes, but that it wouldn't make sense for our son because his  glucose was now normal, and was before low.

Waiting for this appointment has been hard. Our son is not himself. He is drinking a lot, though not urinating a ton. He is constantly hungry (he is my youngest of 3. I know toddler hungry is this is way above the norm). He is one minute very hyper and/or irritable and the next he is very sleepy.

Do you have any thoughts on this? Does it sound like diabetes? What should I look for/do in the mean time?

Thank you!!!

Les

[Deanna L Aftab Guy, MD]

The description you give is not suggestive at all of diabetes, the first episode of low sugar with intussception is expected, during sepsis (high white count) and illness in a small 2 yo child who has not eaten it is not unexpected to find a low sugar, the insulin is normal, NOT too low, this insulin level in the face of a sugar of 85 is appropriate and rules out hyperinsulinemia(a cause of low sugar) and makes us feel better in regards to the low sugar that occured earlier. Diabetes is high sugar NOT low, the insulin level is not the diagnosis, rather a child will have sugar in their urine, high sugar in the blood, weight loss, vomiting, ketones in the urine and blood. In many kids during severe illness they can have nonketotic hypoglycemia-which is now being looked at more and more, if there are no more episodes of low sugar then the first episode was due to lack of eating, prolonged fasting on top of a severe illness that led to low fuel supply(glucose) in a toddler. So followup with a pediatrician who is comfortable with these concerns.
Thanks for your patience, the folder is full and so is my clinic! hope this helps