I’m worried about my four year old son who is pale and has lost five pounds in the last month. The doctor found sugar and ketones in his urine test, but doesn’t seem worried about this at all. I’m don’t know what all this means, and there is a history of diabetes in my family (My father and grandmother both have diabetes; my grandmother died because of it.). Should I be worried?

There are several situations which can cause glucose (sugar) and ketones in the urine so it isn’t always diabetes. However, the combination of these two together bothers me, perhaps more than your child’s physician. I think it would be very, very helpful and important, that your son have a simple blood test done before breakfast one morning soon. This is a fasting blood glucose. If it is normal, that is quite reassuring, nevertheless, if it were normal, I would suggest that he go eat a hearty breakfast loaded with carbohydrates (starches, bread, jelly, pancakes and syrup, juice, etc) and then have the blood test repeated two hours after he eats. If those tests are all normal, then I think you can be more assured that he doesn’t have diabetes today. With the family history, his risk may always be present.

If the levels are abnormal, then you can start taking control of the situation. Not knowing is anxiety provoking and accomplishes nothing. Knowledge is power.

DS

[Editor’s comment: Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal. See Classification and Diagnosis of Diabetes for further information.

Occasionally, lab blood sugar testing might be normal in an early case of diabetes, repeat blood sugar testing at the same or a different time, or performing a glucose tolerance test, might be appropriate if there is a high suspicion of diabetes despite normal initial testing. Another test, the glycosylated hemoglobin, might be used to help confirm a suspected diagnosis of diabetes, but the GHB (also called HbA1c or A1c) is not usually considered as appropriate to make an initial diagnosis. Antibody testing is occasionally done as a screening test in high-risk situations, or as confirmatory of type 1A (autoimmune) diabetes, but is not part of routine testing.

Urine sugar tests or home glucose testing, if done, might be positive, which would make the situation more urgent to get lab testing done to confirm the abnormal results. However, urine or home glucose testing, if negative, would not exclude diabetes.

WWQ]