My niece was diagnosed with type 1 diabetes when she was just a year old. She is now nine. She has been having problems with urinary incontinence when she laughs or coughs or when she is asleep. She is afraid to tell her mother because her mother thinks that my niece is just being lazy. Her blood sugars have been all over the place, up and down, over the years. It is better now that she uses the pump, but has in the past been really out of control. Could she have bladder neuropathy already? How do I convince my sister that this is something she should take seriously instead of getting angry?

From what you say, I think there could be two problems. The first could be some kind of infection sustained by high sugar levels in the blood. In this case, you can simply check for urinary tract infections with a urine culture; if it is positive, your niece can be treated with some antibiotics. The second problem could be enuresis, which means she can’t control her bladder mostly during the night or in particular conditions also during the day. In this case, there could be a familiarity about this (some relatives could have had enuresis when young); enuresis is usually self-limited, disappearing during puberty or earlier. I suggest some tests such as a echographic scan of the abdomen and kidneys, checking for any abnormalities that could sustain enuresis; urinalysis, to check its concentration; and a urine culture. I suggest that you discuss all of this with the niece’s mother and her doctor too, above all because she can feel guilty and uncomfortable with her urinary losses.

AS