From Lake Elsinore, California, USA:
During the course of testing my five year old daughter for diabetes (which she does not have), I bought urine dipsticks to aid the doctor, and I let her three year old brother try using them. To my surprise, he was spilling small amounts of ketones. I kept checking and the level kept going up (over 2 weeks). I called his pediatrician who said he "might just be coming down with something" (he was not spilling glucose). One day he starting acting very strange and smelling very strongly of acetone. I checked his urine and his ketones were 160+. I called his doctor who again did not seem concerned in the least.
I then called a friend who works for an internist who wanted to see my son right away. They did a dipstick test at the office, and he was still reading 160+ ketones but had no urinary sugar. They did a random glucose that read 217 mg/dl [12.1 mmol/L] which the doctor basically said was diagnostic of diabetes.
Because of insurance reasons, I took my son to his pediatrician the next morning but the doctor was still not concerned, and I had to beg to check his sugars. My son hadn't eaten for three hours, and his random blood sugar was 144 mg/dl [8 mmol/L]. She was still not concerned, and he was only spilling trace ketones. I had to beg again for blood tests which were: fasting blood sugar of 74 mg/dl [4.1 mmol/L] ; one hour later, 75 mg/dl [4.2 mmol/L]; and hemoglobin A1c of 4.7%. I have been told these are normal values, but since then, my son is still having periods where he is spilling ketones. I have changed pediatricians, and the new one seems more concerned than the other. Do you think my son has diabetes or may be in onset? I am very concerned as there is a strong family history.
Ketones mean starvation, or in a three year old hunger likely overnight, and he begins to use fat as fuel. That is the most plausible source of the ketones. I wonder if the glucoses weren't in error actually. As far as I can tell, this is likely not diabetes. Any time he is hungry or goes a number of hours without food, he burns ketones, and this might even be normal.
I would continue to look for glucose in the urine for a while. If it stays negative and he shows no signs of diabetes (frequent thirst and urine in the night, then it probably is not diabetes.
Original posting 22 Jan 2003
Posted to Diagnosis and Symptoms
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