Endocrinology (including Diabetes)/Type 1 diabetes signs?

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Question
Hello,

My nearly six year old daughter has been ill since late November, it seems.  During the past two and a half months she's had a stomach bug, then Type A flu (even though she was vaccinated), followed by severe stomach pains for a day or two and now two back-to-back nasty chest colds.  Shortly after she got over the flu (for which she was prescribed Tamiflu), she suddenly started wetting the bed again.  She had been consistently dry at night for 6+ months.  I initially thought she may be constipated (because of the stomach cramps she had off and on), and that was causing the enuresis.  I tried about a week of Miralox, under the advise of her pediatrician, but didn't notice any bowel changes.  She has not had any daytime accidents but soaks her pull-up nearly every night now.

Then, a few nights ago shortly before bed, she became HIGHLY anxious and fearful.  She was extremely agitated and wouldn't allow me to put pajamas on her, stating she wanted to sleep.  She quickly fell asleep - on the floor - but she was very restless.  From about 7:30 pm - 1:00 am she had very loud and fast breathing.  She woke up about every hour or so moaning and whimpering.  She was aware of her surroundings and could answer questions when she awoke during the night.  (She said she was not sick and nothing hurt.)  I noticed some odd behavior similar to tics - when awake each hour or so, she would repeatedly poke her lip quickly and without reason.  At one point, she told me she wanted to get in the bed, and once she climbed in bed, she began methodically tapping on each of the rails of her bed.  Not knowing how to help her, I laid next to her and held her.  I noticed that her body was shaking as if she was cold or terribly frightened.  (She has had febrile seizures before, but this was not seizure-like shivering.)

Suddenly, around 1:00 am I noticed her breathing became normal and she slept soundly until 5:30 am.  She behaved normally the next day, though I kept her home from school to monitor her.

I spoke to her pediatrician the next day as well.  He thinks her behavior may have been a "sugar or caffeine high" from having a bowl of Dairy Queen chocolate ice cream, which she has never had before.  He did tell me to call him - even if it's in the middle of the night - if it ever happens again.

I am concerned that her sudden bedwetting (following a series of illnesses) coupled with this odd behavior may be indicative of Type 1 diabetes.  She has high-functioning autism and tends to struggle with her attention span in general.  I have not noticed that it has decreased recently though.  She is rather thin, but always has been.  Though she hasn't lost weight (46 lbs.) in the past 2 months, she hasn't gained any either even though she has gotten a bit taller.  She has always been a great eater who frequently eats as much as an adult woman, but I've not noticed any kind of appetite increase.  She seems to be drinking a bit more than usual - asking for juice, when I usually just offer milk or water - but her fluid intake hasn't increased significantly.  She also said that her eyes are "fine", but I've noticed that she is rubbing them very frequently in the past few days.  So I'm not sure if she is experiencing any vision issues.

Do you feel that it is possible she could have Diabetes type 1 and that I should speak with her pediatrician about this?  He is aware of the bedwetting and recent nighttime behavioral 'issue', so I'm assuming that he would have brought up diabetes if he thought it was possible, but the more I'm learning about it, the more I am concerned that she may have some symptoms of it.

Thank you!

Answer
Jennifer,
 I'm not a medical doctor and couldn't begin to diagnose your daughter over the Internet, but it is certainly easy enough to test for type 1 diabetes.  Her pediatrician can test her blood glucose level, as well as her A1C value, and pretty much tell you. If it's a concern, it's worth getting checked. Sheri

Endocrinology (including Diabetes)

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Sheri Colberg, PhD

Expertise

I am an exercise physiologist with a PhD who specializes in diabetes--as such I CANNOT answer general questions about other endocrine problems as I am neither an expert in all areas of endocrinology nor am I a medical doctor. My expertise lies in answering questions about diabetes (of any type) and physical activity, so please limit your questions to those areas. I can help you if you want to begin exercise or if you're already a diabetic athlete, and I am prepared to respond to questions about physical activity to which even your diabetologist may not know the answer. I can give suggestions about changes in your diabetic medications that differing types and intensities of exercise may necessitate, but I will have to refer you to your regular health care team to get final approval to make such changes. I can also answer questions about physical fitness, exercise metabolism, prediabetes reversal, and prevention of type 2 diabetes and diabetic complications.

Experience

I have both personal and professional experience in the areas of diabetes and exercise/physical activity. On a personal level, I have had type 1 diabetes since 1968, and I have been an avid exerciser since I was a child. Professionally, I have been conducting clinical studies on diabetes and exercise since 1992, largely with funding from the American Diabetes Association. I am also the author of 8 books related to diabetes, exercise, and more: The Diabetic Athlete (2001), Diabetes-Free Kids (2005), The 7 Step Diabetes Fitness Plan (2006), 50 Secrets of the Longest Living People with Diabetes (2007), The Science of Staying Young (2007), Matt Hoover's Guide to Life, Love, and Losing Weight (2008), Diabetic Athlete's Handbook (2009), and Diabetes? No Problema! (2009).

Organizations
I am a Fellow of the American College of Sports Medicine, a professional member of the American Diabetes Association (and professional volunteer for the ADA), and a former member of the Board of Directors of the Diabetes Exercise & Sports Association.

Publications
I have published research and review articles in the following journals and magazines: Diabetes Care, Diabetes, Journal of Diabetes & Its Complications, Diabetes Self-Management, Medicine & Science in Sports & Exercise, Journal of Applied Physiology, The Physician and Sportsmedicine, Journal of Clinical Investigation, International Journal of Obesity, FASEB Journal, The Diabetes Educator, Journal of Physical Education, Recreation, and Dance, Clinical Exercise Physiology, Clinical Diabetes Reviews, Insulin, ACSM's Health & Fitness Journal, Biomechanics, On the Cutting Edge, Diabetes Technology & Therapeutics, Microvascular Research, Drug Benefit Trends, ACSM Certified News, Diabetes Health, SportEX Health, Diabetes Focus, Diabetes In Control, dLife-For Your Diabetes Life, Pediatrics for Parents, and My TCOYD (Taking Control of Your Diabetes) Newsletter. I have also been interviewed in myriad other magazines, such as Men's Health, Men's Fitness, Diabetes Forecast, Countdown Magazine, Joe Weider's Muscle & Fitness, Health, Tidewater Parent, Barron's News, Diabetes New Day, and Newsweek International.

Education/Credentials
I have an undergraduate degree (1985) from Stanford University, a Master's degree in exercise physiology (1987) from the University of California, Davis, and a Ph.D. (1992) from the University of California, Berkeley, in the same field. I also spent two years in an NIH-funded postdoctoral research position in endocrinology (studying obesity, diabetes, metabolism, and exercise) at the University of Pittsburgh School of Medicine (1993-1994).

Awards and Honors
Fellow, American College of Sports Medicine (FACSM) - 1996 Old Dominion University Darden College of Education Young Investigator Grant Award 2003 Honor Society of Phi Kappa Phi, Old Dominion University Chapter 2004-Present Great Women of the 21st Century by the American Biographical Institute 2005 Edition Old Dominion University Darden College of Education Largest Research Grant Award 2006 Old Dominion University Darden College of Education Publications Award (for greatest number) 2006 Saint Louis University, The Max K. Horwitt Memorial Lecture Distinguished Lectureship Award 2008 Old Dominion University Darden College of Education Publications Award 2009 Old Dominion University Darden College of Research Grants Award 2009

Past/Present Clients
I have consulted for numerous groups, including Can-Am Care, Numera|Social, California Commission on Peace Officer Standards and Training(about candidates with diabetes), Animas Corporation (an insulin pump company), Therasense, Inc. (makers of the Freestyle blood glucose meters), Council of Healthcare Advisors, and the City of Chesapeake (Virginia) Health Department.

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