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August 27, 2005

Diagnosis and Symptoms

Question from Durham, New Hampshire, USA:

My five year old daughter was just diagnosed with type 1 a month ago. She was fully potty trained at age three for an entire year. At age four, she started to have night time urinary accidents, then have them frequently during the day. The doctor did a urine test that came back negative for glucose. She was then referred to a urologist where they put her on medications for what they thought she had, "bladder spasms." The urologist saw her one time in December 2004 and prescribed Ditropan, Immiprimine and Detrol, none of which worked. Do you think that, perhaps, one of the doctors should have done some blood work or even a simple finger poke in the office? I brought her in several times with the same issue and blood work was never done. On July 1, the urologist prescribed the Detrol. My daughter was then admitted to Children's Hospital In Boston on July 6, 2005 in DKA, with a blood sugar over 880 mg/dl [48.9 mmol/L]. Her A1c was 14.9. They feel she had her diabetes for at least six months or longer. Do you think that one of her doctor's should have done a blood test over the entire year that she was having the unexpained urinary accidents? In a phone call to the urologist on July 1, 2005, I explained that she was acting lethargic, peeing large amounts of urine during the day and saturating four pull-ups at night. I asked him how could she be producing such a large amount of urine when we were cutting her fluids after dinner and he stated some kids bladders do not settle down until the evening. I am just feeling sad that my daughter has had to go through this. After her admission to the hospital, she resumed being fully potty trained.

Answer:

Diabetes can present very slowly and it may not be found on a screening urine test. We physicians have all seen patients that present with vague symptoms, or just isolated urinary symptoms, and have normal testing only to show up two weeks later clearly with diabetes. Blood testing is not usually indicated for children with isolated urinary symptoms. Often, parents and physicians have very clear hindsight once a diagnosis of diabetes has been made, which can be frustrating to all involved, including your physician. I’m glad she is receiving good treatment and wish you the best!

MSB