Blood Sugar Levels in Children with Influenza Fever

Q: Blood Sugar Levels in Children with Influenza Fever

Dear Mr. <br>Kelvin：<br>1. <br>There are many diseases associated with fever and rash in children. <br>In our country, it is particularly important to consider varicella (chickenpox), measles, rubella, roseola, enterovirus infections, scarlet fever, infectious erythema, Kawasaki

Blood sugar levels in children with influenza and fever?

Dear Doctor,
Last October, my son (6 years and 3 months old) had a fever due to influenza for five days and had some small red spots on his hands.
We went to the clinic for a follow-up, and the doctor referred us to a major hospital for tests on his platelet count and coagulation function.
Since it was already evening, we went to the emergency department for the tests, where they drew about three vials of blood (I’m not entirely sure as it was a while ago).
An emergency physician then came to ask what we were there for, and I explained that it was due to the influenza fever and the small red spots, and that we were checking for any issues with the blood tests.
The physician reviewed the report and said everything looked normal.
I casually asked about the platelet count, which was 182,000, and then we went home.
The next day, my child’s fever had subsided, and the red spots were gone.
Today, six months later, while casually reviewing my child's health booklet, I noticed that the tests done in the emergency department included a blood glucose level of 197, and part of the activated partial thromboplastin time was also flagged at 38.7, but the physician did not mention these results at the time.

My question is, does this indicate that my child has a problem with diabetes? I read online that a blood glucose level above 200 indicates diabetes, so is my child's situation very close to being diabetic? What can be done to improve this? Thank you!

Kelvin, 40~49 year old female. Ask Date: 2020/06/10

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Kelvin:
1.
There are many diseases associated with fever and rash in children.
In our country, it is particularly important to consider varicella (chickenpox), measles, rubella, roseola, enterovirus infections, scarlet fever, infectious erythema, Kawasaki disease, dengue fever, infectious mononucleosis, typhoid fever, mumps, drug allergies, and others.
2.
According to the American Diabetes Association's diagnostic criteria for diabetes: a.
Fasting plasma glucose level ≥ 126 mg/dL after fasting for at least 8 hours, b.
2-hour plasma glucose level ≥ 200 mg/dL during an oral glucose tolerance test, c.
HbA1c ≥ 6.5% (must not have any disproportionate hyperglycemia, and the testing method must meet the international certification standards of NGSP and DCCT).
The above a, b, and c conditions must be confirmed on two separate occasions.
d.
If there are clinical symptoms of diabetes (such as polyuria, polydipsia, polyphagia, weight loss, etc.), a random plasma glucose level ≥ 200 mg/dL is sufficient for diagnosis (this can be confirmed with just one test).
3.
The diagnosis of diabetes is very rigorous; a single blood glucose level of 197 mg/dL without related symptoms cannot be used to diagnose diabetes.
Your son’s blood glucose may be elevated due to stress from an acute infection; additionally, the presence of a rash may cause temporary coagulation abnormalities (such as a slight prolongation of partial thromboplastin time).
The emergency physician should be well-trained and have considerable experience, allowing them to quickly synthesize these data and related symptoms to make the correct decision.
4.
Risk factors for developing diabetes include a family history of diabetes, gestational diabetes, obesity, hypertension, hyperlipidemia, lack of exercise, overeating, alcohol abuse, use of certain medications, poor lifestyle choices, and excessive stress.
5.
Preventive measures for diabetes primarily involve dietary control, regular exercise, and maintaining a healthy lifestyle.
In practical terms, I recommend: chewing food thoroughly, not overeating (aim for about 80% fullness), and avoiding excessive intake of high-calorie, high-fat, and high-sugar foods or beverages.
Reduce the intake of high-cholesterol and trans fats (often found in creamers, butter, ghee, instant coffee, milk tea, etc.) and high fructose corn syrup (commonly found in commercial beverages, desserts, sodas, pastries, etc.).
These types of foods may be harder for the body to metabolize, can be high in calories without providing a feeling of fullness, and can easily lead to elevated blood sugar levels.
On the other hand, it is important to develop a regular exercise routine, such as playing sports, jogging, swimming, or cycling; in fact, taking a good walk for 30-60 minutes after each meal can be very effective.
In terms of daily living, it is essential to avoid excessive stress and ensure adequate sleep; this will help reduce the secretion of related hyperglycemic hormones and increase the secretion of leptin, aiding in weight control.
6.
If you have any further questions or concerns, please discuss them with your family physician or pediatrician.

Reply Date: 2020/06/10

More Info

When it comes to understanding blood sugar levels in children, particularly in the context of an illness like influenza, it's essential to consider several factors. Your son’s blood sugar level of 197 mg/dL, while elevated, does not automatically indicate diabetes. According to the American Diabetes Association, a diagnosis of diabetes in children typically requires two separate tests showing elevated blood sugar levels, or one test showing a blood sugar level of 200 mg/dL or higher along with symptoms of diabetes.

In your son's case, the elevated blood sugar level may have been a temporary response to the stress of illness. During infections, the body releases stress hormones like cortisol and adrenaline, which can raise blood sugar levels. This phenomenon is known as "stress-induced hyperglycemia." It’s not uncommon for children to experience elevated blood sugar levels during acute illnesses, and this does not necessarily mean they have diabetes.

The normal range for fasting blood sugar in children is typically between 70 to 100 mg/dL. A reading of 197 mg/dL is indeed concerning but must be interpreted in the context of the situation. Since your son was recovering from influenza, it is possible that his body was still reacting to the infection, which could explain the elevated blood sugar. Additionally, the presence of small red spots on his skin could indicate a viral rash, which is not uncommon with viral infections and may also contribute to the overall stress on the body.

As for the coagulation factor you mentioned, with a partial thromboplastin time (PTT) of 38.7 seconds, this could indicate a temporary alteration in coagulation due to the viral infection. Infections can affect the coagulation system, leading to transient changes in clotting times. However, if there are no ongoing symptoms or concerns, this may not be a cause for alarm.

To address your concerns about diabetes, it would be prudent to monitor your son's blood sugar levels over time. If you have access to a glucose meter, you can check his blood sugar levels at different times, especially after meals and fasting in the morning. If you notice consistently high readings, it would be advisable to consult with a pediatrician or an endocrinologist for further evaluation.

In terms of prevention and management, maintaining a healthy lifestyle is key. Encourage a balanced diet rich in whole grains, fruits, vegetables, and lean proteins while limiting sugary snacks and beverages. Regular physical activity is also crucial; aim for at least 30 minutes of moderate exercise most days of the week. This can help regulate blood sugar levels and promote overall health.

If you have any lingering concerns or if your son exhibits any symptoms such as excessive thirst, frequent urination, or unexplained weight loss, it is essential to seek medical advice promptly. Regular check-ups with your pediatrician can help monitor his health and catch any potential issues early on.

In summary, while your son's blood sugar level was elevated during his illness, it does not necessarily indicate diabetes. Continued monitoring and a healthy lifestyle can help manage his health effectively. If you have further questions or concerns, do not hesitate to reach out to your healthcare provider for personalized guidance.

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