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From McKinney, Texas, USA:

Since she was four months old and wouldn't eat, my four-year-old has had a g tube/fundiplication. She had RSV and was on a ventilator during the time she would've started the sucking reflex. Her feeding is Kindercal TF plus 1 ounce heavy cream every three hours during day hours. She gets no night feedings. She does eat table food of every food group, but in very tiny amounts, not enough to sustain her. Her height is 37 inches and weight is 28.2 pounds. She looks good size-wise. My other child has always been on the small size, too. There is no one in our family with any history of diabetes.

The other day, during her four year check-up, her urine had glucose in it. The pediatrician had us go for a fasting glucose and we put the sugar in the tube. The pre-test reading was 80 mg/dl [4.4 mmol/L]. The second glucose was 262 mg/dl [14.6 mmol/L] and the third was 186 mg/dl [10.3 mmol/L]. Her A1c was 4.8. Her thyroid levels were normal. The pediatrician is referring us to an endocrinologist who has seen my daughter before. Her growth hormone was fine on previous visits; she is just a little bug.

So, after reading all over, could she just need a change in formula? I really don't think or feel she is diabetic. I am a registered nurse in intensive care and honestly just don't feel she is. I see "dumping syndrome" once in a while when we raise the volume or the food goes in to fast, but not often. She attends Pre-Kindergarten and is doing well. They have not had any concerns and they give a feeding while there. Does this sound like she has type 1? What will happen next or what should I expect?


The high blood glucose is worrisome. You are correct that this could be a form of dumping syndrome or autonomic dysfunction similar to what causes her gastrointestinal dysmotility in the first place. I would usually recommend intensified blood glucose monitoring, pre- and one hour post-meals for each of the three feedings for about a week to see what levels she has. The A1c being normal suggests that these are not consistently high. Testing for islet cell, insulin and IA2, as well as GAD-65, antibodies would be helpful. If positive, this would suggest she is developing classical autoimmune diabetes; if negative, it will not be diagnostic. I would also agree that seeing the pediatric diabetes team would be very important and sharing these home blood glucose values will be helpful.


Original posting 7 Apr 2008
Posted to Diagnosis and Symptoms and Hyperglycemia and DKA


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