Sunday, June 9, 2013

Two for One

A middle-school aged kid went to his Pediatrician this week with the complaint of headaches, fever, and a skin rash. The Pediatrician suspected Lyme Disease and send off some bloodwork.

He sent the kid home with some doxycycline and called the mother the next day to report that the electrolyte panel he ordered showed a blood glucose level of 268 mg/dL. He asked the family to come into the office for a re-check. It was 270 mg/dL.

He was sent to the ER and that is when I got called.

I really doubted that this kid had diabetes. He had absolute no symptoms of diabetes such as drinking too much, peeing too much, waking up to pee, weight loss, etc.

Zero, zip, nada. 

With only a random blood glucose over 200 mg/dl, you cannot diagnosis diabetes without the classic symptoms. After continuing to question the presence of those symptoms, he just shrugged and said “I feel great!”

So I ordered an A1C and he got admitted for a little more observation. We checked for ketones every time he peed and measured his blood glucose before and after he ate.

I came in to work this morning expecting to tell them that this was simply “stress hyperglycemia”, or elevated blood sugar in relation to illness. It goes away once your illness resolves.

But the A1C came back at 6.8%. To us established diabetics, this sounds excellent. But to a person without diabetes, this means they now have it.

I always have a hard time breaking the bad news of new-onset Type 1 to families. This time was especially hard. I had to tell them that, despite their son feeling so good, he now has this chronic illness that will change all of their lives forever. He came into the hospital with one diagnosis and left with two.

It is never an easy thing to do, but at least when new-onset patients are dehydrated from peeing and gaunt from weight loss and breathing heavy from ketones I can swoop in with insulin and make those patients feel better than they did when they came in. I can give the family an answer to the bizarre symptoms that plagued them in the weeks leading up to that day.  I can provide hope.

Today, there was no silver lining to that dark cloud.  I had no chance to make this patient feel better. I only made things worse.


  1. My daughter's was caught super early too... We went in for a 12 month well-child visit, during which the pedi took a urine sample. The next day we were admitted into the hospital. Her first a1c was 6.5. We were blindsided because there were no signs that anything was wrong...
    I know our pedi STILL feels awful about that day.

  2. That must feel really hard. I'm sorry.

  3. Had to be so hard. He ansld his family were very lucky to have you though.

  4. What a tough thing. I've never considered the angle of the person feeling fine when they come in...

  5. Thanks, guys! It's not the usual way of diagnosing kids and I found it much more difficult, though it is good that the patient did not go undetected for months longer and risk going into DKA.