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July 16, 2006

Diagnosis and Symptoms

Question from Pembroke Pines, Florida, USA:

My boyfriend has been experiencing some unusual symptoms lately and as someone with a biomedical engineering background, I have been researching and look up his symptoms, and we have found them quite perplexing. He is 27 years old, overweight (260 pounds), gets little to no physical exercise, has borderline high cholesterol and high triglycerides (a family history), takes beta blockers for a sinus arrhythmia and heart palpitations, and Nexium for GERD. He does not have a family history of type 2 diabetes. He has been peeing a large amount lately. Basically, he'll urinate and then, 20 minutes later, he'll have to go again, each time, having a strong stream, peeing a large amount of fluid, and all of it clear. Given his background, we immediately suspected diabetes. I have an available glucose meter, so we started checking his numbers. I coded the meter properly and performed the control solution testing. I have done lots of research on glucose meters in my studies, so I know all about the accuracy of meters and that, of course, you cannot diagnose diabetes on a home meter. His numbers came out as follows: 132 mg/dl [7.3 mmol/L] two hours after eating; 104 mg/dl [5.8 mmol/L] fasting; 90 mg/dl [5.0 mmol/L] two hours after eating; 97 mg/dl [5.4 mmol/L]; 111 mg/dl [6.2 mmol/L] two hours after eating; and 105 mg/dl [5.8 mmol/L] fasting. His last official laboratory blood work, about two months ago, came out with a fasting glucose of 101 mg/dl [5.6 mmol/L] and an A1c of 5.7%. Basically, from his readings, I told him that these numbers, while were not too concerning for diabetes, could lead to insulin resistance and that he needs to start doing something about his weight and exercise, because he's a strong candidate for developing metabolic syndrome. But, we're still puzzled with his excess peeing. He wakes up several times in the night to pee and throughout the day, he pees, saying that his urination has increased by about 50% of normal. We were thinking diabetes insipidus, but what's really odd though is that his fluid intake has not increased at all. He's not craving water or drinking too much of it. I know there are other metabolic and endocrine issues that could cause this, such as thyroid and/kidney issues, but nothing really seems to fit him. He has a doctor's appointment soon and I'm sure more blood work, but we were just looking for some answers in different directions to provide more insight as to what may be going on.


I do not think it is diabetes either. You are right; it could be diabetes insipidus. He needs to have urine volumes per 24 hours obtained. When you see the doctor, this would be good to have. He will also need blood and urine chemistries. There may also be the possibility of a bladder or prostate problem with inadequate emptying of the bladder. This should be looked into as well.