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September 28, 2004

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Question from Milford, Iowa, USA:

I am a school nurse and have a concern about a 17 year old female student. She is a distance runner and becomes incontinent (large amount) as she is close to finishing her race. Apparently, this happens every time she runs. I believe she is running approximately three miles. She was diagnosed about four years ago. She started out requiring insulin for control. Within three months, her blood sugar returned to the normal range. She then went for about three years without medication, would just test and watch her diet. She now takes six to seven units of Lantus every morning.

The situation regarding the incontinence has just come to my attention, although I understand it has been happening to her for three years in track. I just need some input before I visit with her and her parents. I hope I can help her in some way. Is this incontinence something that could be expected, or is it unusual and cause for alarm?

Answer:

From: DTeam Staff

I would really be surprised if it were concluded that this incontinence were related directly to her diabetes: she has not had diabetes long and it sounds as if her glycemic control is good.

The fact that this occurs when she FINISHES a race maybe an important clue that really suggests some neuromuscular/sympathetic-parasympathetic regulatory problem. It would be interesting to know if this occurs at every race, every time, whether a competition or in practice, whether a long run or a longer run, or even a moderate sprint.

I think that a review with a nephrologist or urologist for urodynamic testing, which unfortunately can be very uncomfortable, is in order as may a conference with a neurologist. Depending upon more details of the history, I’d even consider MRI scanning of her spine.

That’s the opinion of this pediatric endocrinologist who clearly must disclaim that he is not a nephrologist, neurologist, or urologist.

DS
Additional comments from Dr. Stuart Brink:

This is extremely rare and likely totally unrelated to her having diabetes, unless it is a strange symptom of hypoglycemia. This would be easy to verify and only entail her stopping every 15 minutes for a five second blood glucose check to see if there is any pattern of BG changes during her running. I would suggest a formal urological consultation to make sure that there is no anatomic or infectious explanation.

SB

[Editor’s comment: Also, I would suggest you find out if she is drinking juice or a sport drink prior to the race to prevent hypoglycemia. If this is the case, she should consider using something other than a beverage. As stated above, she should consult a physician.

BH]