Fasting glucose of 4.5 in 22 month old..??

[lanam]

Hi everyone. I'm new here, will post an intro as soon as I can.

I got my 22 month old tested at a walkin clinic (they were AWFUL, very ignorant) and her blood glucose came in today. It was 4.5...She had fasted: no water, nursing, or food from 9pm till about 11:30 am the next day (so over 14 hours)

The dr. wasn't in so I couldn't discuss with him, but what does this mean? The bottom of the range was 3.5ish something like that. The receptionist gave me the info even though she "wasn't supposed to".

Here is some info about her behaviour/possible symptoms:

She screams, she's up in the middle of the night for hours, she tantrums, she runs away while out, she climbs, she repeats things over and over incessantly in the loudest most dreadful high pitch voice, she fidgets, she goes limp into a pile on the floor, she pushes, she grabs, she is SO SO SO SO loud, she is instigating something with her sister 24-7, starting before dd1 is even up. The sheer volume of her voice is enough to keep us on edge. Just very frantic in her behaviour at random times throughout the day.

A couple days ago was the kicker. I took them to the library (by bus) to get some books/play. I made sure she was fed, had extra water bottles with me (she asks to drink A LOT all day long), took her to the bathroom before we left and while we were there (she's 99% pottytrained), tried reading books to her, tried playing a puzzle with her...NOOOOOO She is running around like a madwoman pulling books off the shelves and throwing them around the library. By the time I picked up a book she was over at another shelf doing it again. She was bothering these 2 kids that were playing some game, started YELLING at them to GO away, to STOP (did I mention she has a SHRILL voice), no amount of modeling a quiet voice, reminding her, distracting her, redirecting, stern voice would get her to leave those girls alone. She then pushes her way through to play with a toy that another baby was playing with and made the girl sob and sob. I thought maybe she's hungry again. Took them to the cafe taht's in the library. She's screaming and shouting and standing in the chair and grabbing EVERYTHING in sight, climbing on top of the (wobbly) table, and when I would try to 'contain' her (ie. put her in my lap or just talk to her/redirect) she's go limp and start SCREEEEEEEEECHING.

I have to also mention she hardly EVER gets sugar, NO dyes of any sort.

The nightwaking/wailing/crankiness (which is often b/c of the need to pee--she gets up to pee at least 5-6 times at night) and the fighting with her sister are the absolute worst.

She is *constantly* thirsty, always asking for water (come to think of it asks to nurse soooooo often as well perhaps thirst??), going nuts if it's not right this second. She is the same with food (however moreso for water). Always wants to eat, same thing, throws full out tantrums over food. I wouldn't say she overeats though at all. Just lots of eating throughout the entire day.

something else that she does ... it 'looks' like what I think a seizure might look like ..she goes completely limp, not breathing, turns blue, after a few seconds she kinda jerks her body slightly- most often when she's hungry

Can anyone help me possibly figure this out?

Thanks so much in advance.

[lanam]

forgot to mention she had strep throat about 9 months ago, and it was soon after all this craziness began..

[Amy C.]

These are the absolutely terrible twos.

It would be helpful to know what country you are from.

If they are measuring the blood sugar level using mmol/l, as Canada or Great Britain does, this is a little on the low side. If this is in the states, and this is an A1c measurement, this is in the normal range.

I don't think any of us are doctors on this forum.

I recommend that she get a full checkup from a pedicatrician. I woudl guess you would need someone to go with you to contain the child while you talk to the doctor.

All I can say is this is not normal behavior for a child. The part where she goes limp and then revives herself is very unusual -- I have never heard of that as part of the symptoms of diabetes.

Usually diabetes has a weight loss involved as well as the thirst.

[lanam]

yes we are in Canada.
and she is not like this all the time. Just randomly..I realize some of it is 'being 2' and she's not my first child to go through the tantrums etc. but it's just so exaggerated and random..

I'm still confused I guess by low and high blood sugars and what the effects are in terms of behaviour for example. I realize doctors may not be posting, but just was hoping for some been there done that advice/info.

someone I spoke with mentioned the going limp as a sign for their child of their blood sugar getting too low *shrugs*

[3js]

I got my 22 month old tested at a walkin clinic (they were AWFUL, very ignorant) and her blood glucose came in today. It was 4.5...She had fasted: no water, nursing, or food from 9pm till about 11:30 am the next day (so over 14 hours)

The dr. wasn't in so I couldn't discuss with him, but what does this mean? The bottom of the range was 3.5ish something like that. The receptionist gave me the info even though she "wasn't supposed to".

4.5 for a 22month old is low, IMO. When we were at d-training at Children`s Hosp., they gave the 3yr old training along side us a range of 6-12. My son is 10, and his range is 4-8, but we treat 4 as a low with fastacting glucose and a follow-up snack.

Are you able to get your daughter in to see a family Dr., or someone other than in a clinic?

Can I ask why they had her go without food/water for so long?

[lanam]

Thx for the reply.
I'm new to all this and dont' know what i'm talking about :)

her doctor is not available as her mom passed away and dont knwo when she'll be back..Do you think this is a case of I should get in somewhere asap?? I'm sorry like I mentioned I really dont know what to think

Her bedtime is at 9pm so during the night she wasn't eating/I didnt let her nurse in the early am when she usually does :( and when I got to the lab it was PACKED adn they refused to let the FASTING less than 2 year old get ahead of teh line..so didnt have her bloodwork done till 11:30. It was a crazy day let me tell you.

[lanam]

also, what does low blood glucose mean/indicate?
I'm confused, I thought diabetes was blood sugar that was too high

[Amy C.]

If her blood sugar was 4.5, that is not low for a nondiabetic. This translates to 81 mg/dl. A non diabetic goes between 60 and 120.

With a fasting sugar like that, she won't be dx'd with diabetes. It sounds like she needs to eat regularly to keep her sugar levels up -- that she may be hypoglycemic or having low blood sugar.

I would take her to another doctor -- she must have a backup for when she is out of town.

[Abby-Dabby-Doo]

Please don't quote me on this, but I thought an A1C (if that's what you had done) of anything over 6.0 can be concerns of a diabetic. I'm sorry but the numbers that you've posted are of a different understanding from what we know. I don't know what your test translates into with US numbers.

My daughter woke up a lot in the middle of the night, thirsty, frequent urination, terrible stomach aches, dry skin (chapped lips), erratic behavior (grumpy or tired), and pains in her legs.

That sounds like an awfully long time to go without food or drink, I'm uncertain why they had you do this.

Your mommy radar is going off for a reason. Something is not right, whether it's diabetes or not. No 22 month old child should be going limp, turning blue, on the floor. I would insist on some treatment somewhere where you trust the facility, immediately.

[lanam]

This was not an A1C test. It was just a regular blood test. We are in Canada where I believe the units are in mmol/L (normal range being 3.9-5.5 according to this site http://www.labtestsonline.org/understanding/analytes/glucose/test.html ...
the U.S. uses the range of 70-99mg/dL as normal, correct?

Are there other tests I should look into with regard to diabetes? or is it pretty much a done deal that if your blood sugar shows up 'normal' then you rule out diabetes?

[kiwikid]

4.5 mmol/l as a fasting blood glucose is great.
I don't believe that the symptoms you are decribing (apart from the water drinking and peeing) are related to Diabetes. Our children do not have behaviour problems as you are describing that is part of their Diabetes . This could be the terrible twos, or there could be other factors involved. Your Dr should help decide whether you need to seek further advice with therapists or psychologists. You do sound as though you need time out for yourself. Do you have anyone who can help?

Both high blood sugars and low blood sugars are part of Diabetes. Its a balancing act between food, insulin, exercise and a hundred other things. If anyone of those things is miscalculated, then low blood sugars can occur. Usually a diagnosis of Diabetes is based on high blood sugars though.

[lanam]

I have to mention that my first post is a cut and paste of a post I made on another forum for gentle discipline. It originally did not start out as a health concern...Most of the moms on there pointed out the drinking/peeing as a concern and mentioned looking into diabetes. I was like HUH?!?!? I was posting for advice on some techniques, didn't think about a serious health issue like that.

I hope no one thinks that I'm assuming children who are diabetic misbehave due to their illness or anything like that. After all those posts urging me to look into testing for diabetes I came here to look for info and talk to more moms with kids who are diabetic. I thought I'd add the whole post to give a bigger picture and thought maybe *for her* high or low blood sugar gets her into these 'moods'.

For some reason I feel I'm being misunderstood so I just wanted to clarify.
I do appreciate the help.

[Hollyb]

Hi,

We're in Canada. Normal non-diabetic range is 4-6 so your 2-year-old's fasting blood sugar is pretty much perfect. You might expect higher after she's eaten.

I hope your doctor will keep looking -- the peeing and thirst are symptoms of diabetes but most of the other observations you make aren't really.

If everything checks out health-wise, you might want to grab a copy of the book "Raising your Spirited Child." Some kids are born with rather "difficult" temperaments, things like low frustration tolerance or high sensitivity/reactivity to the environment which can make for some pretty extreme behaviour.

(Can't believe they didn't let a toddler go first. That must have been a tough morning!)

[lanam]

So is this the only definitive test? What I mean is after just this one test this can be ruled out? or can diabetic or pre-diabetics have normal bg's sometimes?

[3js]

Was she tested at the clinic with a meter? I don`t think one meter test would rule things out. I`m very new to diabetes though. I know a child can have ketones without high BG`s, and d-kids don`t have high bg`s 24 hrs a day. I think the going limp, ect is enough on it`s own to warrant being referred to a pediatrician.

As an aside: when my son was a toddler, I started going to a clinic nearby instead of a family docter. It was SO much more convenient. However, soon his asthma started getting out of control, the Dr`s always differed in their assessments/treatments. When I went to my family Dr. she said that for kids, continuity in medical care is imperative. There are SO many variables which determine a diagnosis, and having ONE Dr follow the child makes it much easier to pick up on things quickly.

I don`t know if this is where you normally take her. Just wanted to share my bad experience:rolleyes: I figured a Dr is a Dr. So what difference can it make. But it didn`t work out well for us.

My son didn`t have EXTREME behavioural problems at dx, but he felt awful, and had been VERY crabby and difficult in the month prior to dx.

I hope you are able to find some answers. It must be terribly frustrating. ((hugs)) to you and your daughter.:cwds:

[Mama Belle]

So is this the only definitive test? What I mean is after just this one test this can be ruled out? or can diabetic or pre-diabetics have normal bg's sometimes?

To answer your question, no this is not the only definitive test. When people are in the earliest stages of developing diabetes they can have a normal fasting result but have elevated post-prandial (post-meal) numbers. You can request having additional tests done like an HbA1c blood test done and a C-peptide test. However, with the result that you just received on this recent fasting blood glucose test a doctor may be reluctant to order these other tests. You may be best to wait a couple of months and monitor your child's blood sugars at home. If the blood sugars start to creep out of range then you can go back to a doctor with your home testing records and request the additional testing. Kids can have a slow onset of diabetes for months and even years, so while this recent test may be normal, one in another 9 months may be abnormal.

Regardless of whether or not this is Diabetes, I would definitely seek a doctor's help in figuring out the symptoms you described about the seizure-like phases she goes through.

Here is some more information for you about the testing and home monitoring.

-The HbA1c test (http://www.childrenwithdiabetes.com/d_06_h00.htm) measures the overall average blood glucose level for the past 90 days, however it is most indicative of the most recent 4-6 weeks. If your child is experiencing normal fasting number but elevated post-prandial numbers then the A1c may be slightly higher than what would normally be expected.
-The C-Peptide (http://diabetes.webmd.com/C-Peptide) test will measure the level of this peptide which is almost always exactly equal to the levels of insulin. So if insulin levels are low, the C-Peptide will also be low and the converse is also true. A low C-Peptide would most likely point to type 1 diabetes where as an elevated C-Peptide might point to type 2 diabetes.
-Home monitoring is blood glucose testing you can do at home. You can purchase a Side Kick blood glucose meter for $35 US at Walgreens.com (http://www.walgreens.com/store/product.jsp?CATID=100133&navAction=jump&navCount=0&id=prod2009773). It comes with 50 test strips and is a small meter used to test blood glucose. You must record the values when you get the reading as I am pretty sure this meter has no memory function. Other meters can record the readings in memory but they generally are much more expensive and the test strips are very expensive to purchase without a prescription. If you are concerned about diabetes I would recommend testing first thing in the morning (representing a fasting number) and 1-2 hours after eating a meal. Any number over 11 mmol/L post meal would point to type 1 diabetes. Any fasting number over 8 mmol/L would concern me. always wash and dry hands thoroughly before testing as any residue can seriously skew the results in either direction.
-Another alternative to testing blood glucose at home, which can be hard on kids, especially the wee ones, is to test for glucose in the urine. You can purchase Diastix (http://www.walgreens.com/store/product.jsp?CATID=100133&navAction=jump&navCount=1&id=prod4782) for around $11 US at Walgreens.com (and probably at your local pharmacy). You either can hold the strip under the urine flow for a couple of seconds or you can have her pee in a cup and then dip the stick in the cup. You get your reading by comparing the color on the tip of the stick to a color chart on the container. This is a much less invasive way of screening for high glucose. However, glucose typically does not spill over into the urine until blood glucose is above 200 (or 11 mmol/L). This means she has to have consistent repetitive blood glucose readings of 11 before it will show in urine.

One last thing (sorry this is already so long, but I want to help you) ...

I hope no one thinks that I'm assuming children who are diabetic misbehave due to their illness or anything like that. After all those posts urging me to look into testing for diabetes I came here to look for info and talk to more moms with kids who are diabetic. I thought I'd add the whole post to give a bigger picture and thought maybe *for her* high or low blood sugar gets her into these 'moods'.

I don't think anyone misunderstands you. Most of us notice behavioral changes in our kids during bouts of high blood glucose and many of us noticed this as a symptom during onset. I don't think it is unreasonable to associate a behavior change with a possible medical condition. As far as I am concerned I think it is an astute observation. :)

To sum up, I do not think your daughter is in eminent danger with respect to the development of diabetes. If she were, her fasting number would have been substantially higher. However, I do think that the prudent path at this point would be to be watchful of her symptoms and numbers. Also I would definitely investigate the other symptoms (seizure-like stuff) you described with your doctor. That would worry me very much.