Ask the Pediatrician: Dr. Molly

Child's huffing and puffing: juvenile diabetes unmasked

Breathing fast. That was the only thing obviously different. The symptom I couldn't explain.

T's mom e-mailed me one Saturday and said the 2-year-old wasn't eating well but was drinking lots, and that he was breathing faster than normal. I asked my usual questions: Fever? No. Cough? No. Vomiting or diarrhea? No. Any obvious pain? No. So I suggested they give it some more time and see if it was evolving into an illness, and fever or cough would come.

They waited. Sunday came, and with it T's breathing got more rapid and even seemed a bit labored at times. By 5 o'clock, his mom called me on my cell, and we talked about his symptoms. They seemed nonspecific: He was a little more tired than usual and didn't want to eat at all that day, but would still drink his fluids. He was peeing fine and having normal stools. Still, no fever or cough or runny nose or anything that would explain his increased work of breathing. So after going back and forth about whether or not he should be seen that night in the ER, T's parents took him in. He had plenty of oxygen in his blood, his chest X-ray was OK, too, and his throat looked nasty. He remained a mystery even then for quite some time. The resident and I talked by phone and planned to get an EKG to see if he had a viral heart infection causing early heart failure as a reason for his rapid breathing.

Then an experienced nurse gently asked the parents if T's breath usually smells fruity and suggested to the resident that she do a blood-sugar test. T's blood-sugar level was more than 500 (normal is 70-120 mg/dl), and his body was so sick and overwhelmed that acid had built up in his blood, and he was breathing quickly to eliminate some of that acid.

T was diagnosed with juvenile onset diabetes then and there, and was transferred to the Pediatric Intensive Care Unit to get his blood sugars and acid buildup under control.

When many people think of diabetes, they picture an overweight adult who has gone for months, maybe years, with his illness undiagnosed. This is a very accurate picture of adult onset diabetes. Juvenile onset diabetes is aggressive and potentially lethal if not diagnosed quickly. When children first develop diabetes, they are like T; in a matter of days they go from being themselves to being very, very sick with weight loss and excessive thirst and hunger, and eventually become so acidotic that they are breathing really fast to compensate. Because T was so young, he just seemed to be getting sicker without other symptoms and couldn't tell us how he felt in words. He could only drink a lot and breathe really fast. And had he been seen over a couple of days, his weight loss would have been apparent, and this cardinal sign of juvenile diabetes would have triggered the diagnosis.

Juvenile onset diabetes is usually not mysterious and is easy to test. If you see your child drinking a lot, eating a lot, peeing a lot but appearing thinner and sicker as days pass, be sure to get him in to see his doctor right away!

Dr. Molly O'Shea is a Troy-based pediatrician. Read Dr. Molly's blog, get answers to your questions and discuss children's health issues at detnews.com/drmolly.