Daughter Concerns

So having a bit of a concerning and confusing time here…

I took my daughter to her pediatrician today because she has been having frequent fevers w vomiting (4 episodes in 4 months)…it’s been happening whenever she is exposed to a sickness. I was concerned her cell levels were low (cue my leukemia freak out).

However, when the dr got her urine results back he found she was “dumping ketones and glucose”. He then ordered a finger stick and it was 179. He said the threshold for an automatic endocrine consult was 200 and so we will follow up in a week because maybe she is just dehydrated. She threw up once prior to the appointment and only had a few bites of pancakes since the night prior. However, everything I am now reading I cannot find where glucose in the urine is linked to dehydration. The more I am thinking about it and processing this information, the more the diagnosis would make sense. Some the dr pointed out: over the last 2 years she went from the 50th to the 10th percentile and isn’t gaining great weight. We always attributed that to her asthma meds. However, lately she has a yeasty looking rash on her bum that I hadn’t given much thought to until now, she complains of frequent belly aches, she drinks a lot of water before bed, and in the last few weeks she has started to wet the bed when she was previously potty trained (however, didn’t put it together because her grandpa just died so I just thought she was stressed/upset).

My overall question, does this sound like anybody else’s beginning journey? Does anyone have any insight?

Thanks

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@Rebowman
Do you have a glucose meter? Are you able to get one quickly?

Waiting a week as the doctor suggested is not ideal. A lot of the signs you are describing - weight loss, frequent urination, thirst, vomiting - those sound like they could be diabetes. I had all of those. I was 5 years old.

A short spike up to 179 and then quickly returning to normal is not necessarily an issue. But if she spends time with elevated blood sugar, that is more of a concern.

Where are you located? Is it possible to go back to the doctor sooner than a week? Can you get a meter and do some checks yourself when she wakes up and after she eats?

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I agree with Eric.

1.) You can buy a blood glucose meter at Walmart or Walgreens over the counter.
2.) You will also need to buy the test strips that match it because they don’t come included inside anymore.
3.) Buy a lancing device (looks kinda like a pen) and box of lancets to prick her finger for blood to put onto the testing strips. A lancet goes inside the lancing device.
4.) You can watch a youtube a video on how to test her sugar by googling the specific meter type.

The machine and the strips need to be of the same brand, but the lancing device does not need to be the same brand. It just need to match the lancets. A pharmacist might be of some help (but, not always).

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Yes, I can go buy one. I didn’t realize they were OTC and asked my dad who is a diabetic (T2) to bring his over. Should I test before or after she eats? If after, how long after? I was also going to buy the urine strips to see if she still has glucose in her urine. I was going to call dr and see if we could do a fasting glucose or if we could figure something else out, I just didn’t know what. It’s all been a whirlwind.

Thanks!

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Please get a meter asap, they aren’t that expensive and great to have around anyways. Also ketone strips.

This is important because if she has/had ketones, that can cause nausea and can be deadly unless treated.

Young children get sick fast from diabetes, you don’t always have a lot of time. So if she still has ketones or her blood sugar is staying high I would be tempted to go to a pediatric emergency hospital if you have one near, or just emergency if you don’t. If she has ketones it’s a sign of DKA. Do not wait a week to see if she gets sicker.

If she turns out to be fine, you are just a worried parent, but if something more serious is going on, it’s best to catch it sooner versus later.

Unfortunately while there are a lot of type 1 diabetics, at the same time there isn’t.I once read where a regular doctor might only see one or two type 1 diabetics in their lifetime. They make mistakes.

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Yes - I was going to get strips tomorrow and start testing. He told me because she wasn’t high on her blood sugar that she was just dehydrated and that’s why she had ketones but it still freaks me out. I will take her to ER if she still does tomorrow

The ketones are key which means she is probably diabetic.
Sugar doesn’t spill into urine until over 170 so it sounds like she’s been high a while. Ketones come when she doesn’t have enough insulin to supply her bodies needs and she is breaking down fat and muscle to have enough energy

Luckily type1s often have some ups and downs before it is really serious.
I wouldn’t put up with a glucose over 170. I would insist on some tests.
If it were my daughter I would be looking for a pediatric endocrinologist or taking her to children’s hospital.
DKA can come on fast. And it is serious.
You can’t over react. Get her in and properly diagnosed. Don’t care if thy think you are over reacting.

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Test right away. You need to know how high she is before she eats, it can make a difference on what she can eat. If she starts vomiting again, go to emergency.

Diabetic Ketoacidosis in Children - What You Need to Know.

Sorry, not trying to be an alarmist, but so many in here were diagnosed because they got DKA as a kid. And with kids it’s better to be safe than sorry.

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Test both before and after meals and write down her numbers. 2 hours after a meal she should be back under 140mg/dl. Urine is behind blood by at least 2 hours so your daughters blood glucose (BG) may have been high enough 2 hours before the Dr. tested her urine to be spilling ketones and or glucose but not high enough to do so in real time.

This really sounds like early type 1 to me but some children can get high BG’s from illnesses. However the thirst is one of the most prominent diabetes symptoms and you definitely need to watch the situation closely and if BG is over 200 consistently or she is producing ketones take her to the hospital.

Dehydration is the dangerous part of having high BG’s not necessarily the high BG itself because dehydration damages the kidneys. Throwing up and excessive urination will dehydrate you very fast so make sure she keeps drinking lots of water or sugar free Gatorade.

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Thank you for saying that because everyone is acting like I’m over reacting. I’m an ICU nurse (adult) and I’ve taken care of people in DKA. It terrifies me. She seems fine right now but if this was caught by chance and is now going to snow ball, I feel like we need to be proactive.

I’m getting the testing stuff this morning. She is awake and asking to eat. I don’t think I will be able to get the stuff before she eats because she has asked me multiple times to eat now and her sister is still asleep. :woozy_face:ml

I will start logging symptoms and sugars as well. If she hits high sugars and glucose/ketones in her urine, I will probably go in.

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You know it’s a funny thing. I worked in hospitals and laboratories a long time. As staff we are conditioned to follow the doctors orders even when we don’t agree. Especially nurses.
That conditioning plays into your thinking when you are in there with your daughter.
A little pushback is needed here. You are in the patient zone now.
If your daughter eats some heavy carbs this morning, it can be a sort of glucose tolerance test.
Good luck with that today.

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Picking up the meter now from my dad. She has had 3 cheese sticks so far so is it ok if I try to load her up on carbs or just feed normal?

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If you want to see if she’s got a problem, I would give her carbs.
If she shoots up, you will know.
If you keep her low carb it could delay a need for insulin for a while, but kids usually have a fast progression anyway.

She will need 75 grams of glucose or more to do a gtt
Test before the carbs and every 30 min for 2 hours.

Pancakes w syrup will do it. A coke won’t be enough. You can look at labels.

Looks like her ketones are reading “small” this morning

It is very helpful to get an idea of how the glucose changes. I would test when she wakes up, or before she has eaten anything. Then test about 30 minutes after a meal, and then again 2 hours after a meal.

Before eating, you would want to see something below 100. Right after eating, a small spike up is not too alarming. It depends on the amount of carbs and how fast-acting they are. And then 2 hours after eating, her blood sugar should be back down to normal.

Those are the things to look for.

Any extended stay above 140 or 150 indicates some issue. It may be diabetes or could be other issues. The main thing is if the blood sugar stays elevated or comes back down reasonably soon after a meal.

Kraft Dinner is exceptionally carby (160 grams per box). Try that for lunch

Ok. She didn’t eat much for lunch - half an apple, 2 cups of milk, and a few sticks of Graham cracker. We will make the Kraft Mac and cheese for dinner.

Her beginning BG was 71, which is good! I’ll retake in a hr!

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People saying ketones likely indicate T1 diabetes are not correct, at least not with a blood sugar that’s not particularly high and this kid’s history. She might have diabetes (certainly possible, your testing should discover it), but she could very well be spilling ketones if she’s not getting enough food into her system from vomiting, and being dehydrated from the vomiting won’t help. The body will turn to burning fat stores in that situation, which is what produces ketones, even if insulin production is fine. It also will just get a bit off, metabolically. That’s a perfectly typical bodily response to that situation in a non-diabetic, especially if we are talking about small ketones and not ketoacidosis risk levels and without notable hyperglycemia (179 is not really that high).

Also I hope you figure out what’s going on and she feels better soon!

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FYI, those urinalysis strips are inadequate. They only show ketones, which can happen for many reasons besides diabetes.

Just go to Your nearest pharmacy, or Walmart, Target, etc… Even major grocery stores. They will all have an aisle near the pharmacy related to Diabetes paraphernalia. You need a blood glucose meter (glucometer). It’s the only way to tell. Most come in a starter kit for under $20 that has everything you need at first, including test strips, a lancing device, and lancets. R starter kits don’t have many test strips, though. You’ll probably want to go ahead and pick up a box of test strips that match the meter, so you can do more than a few glucose tolerance tests.

As mentioned before, feed her a carby meal. Pasta, Chinese, big bowl of sugary breakfast cereal, etc… Test her glucose with the meter before the meal, and then then 30, 60, 90, and 120 minutes after the meal. Short high bursts are normal. Staying high for extended time is not.

Since 200 is the number your pediatrician alerts at, report each and every instance you set over 200. If at any point she’s vomitting and spilling ketones in her urine, take her to the E.R. Do not screw around, do not wait for the pediatrician to call you back. Vomitting + ketones = a highly dangerous situation. If she’s vomitting and NOT spilling ketones, and you’re not seeing upsetting numbers on the glucose tolerance tests, then you’re probably barking up the wrong tree with diabetes… But I’d be looking for a different pediatrician for a second opinion. Recurrent vomiting and ketones is a sign of metabolic distress of one way or another.

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I was diagnosed in 1976. After the initial discussion of symptoms and maybe some labwork, the internist sent me downstairs to the building restaurant and had me eat pancakes and syrup and come back in two hours. I’ve always said that I was diagnosed by pancakes.

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