T.N., a four year old female, is brought to the doctors office by her parents, who complain that she has been eating and drinking all the time for the past three weeks, yet has lost five pounds. Further history reveals that T.N. has been irritable and awakened two-to three times in the night to urinate. She had a week-long upper respiratory infection approximately two months ago but, in general, has been very healthy.

Physical examination reveals a thin, irritable white female but no other abnormalities. Laboratory studies show:

Blood Count: normal

Urinalysis:

Specific Gravity: 1.040 (nl: 1.005-1.015)

Clinitest Tablet (glucose test): 4+ positive (nl: negative)

Acetest Tablet (ketone test): 3+ (nl: negative)

Glycosylated hemoglobin: 17% (nl: 5.4-7.4%)

1. What is your diagnosis?

2. What is glycosylated hemoglobin? What do elevated levels reflect in this patient?

3. Is there a relationship between the previous upper respiratory tract infection and the present diagnosis?

4. What are the long-term complications of this disorder?