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December 15, 2000

Diagnosis and Symptoms

Question from Helena, Montana, USA:

Two days ago, I took my four year old daughter to the doctor because I thought she might have a bladder infection. She gave a urine sample. She had had several bites of cereal and approximately a cup and one-half of grape juice within an hour and one-half hours before the sample. She did not appear to have an infection, but the nurse practitioner came in and told me she tested positive for sugar (2+) and ketones. She then told me that my daughter could very possibly have diabetes, and that I would have to be prepared to take her to the hospital. They drew a blood sugar which was 136 mg/dl [7.6 mmol/L]. The nurse told be to bring her back in a week for a fasting blood sugar. My daughter shows no signs of diabetes. If anything she is drinking less than normal, and her urine is very strong. (like ammonia sometimes). I called the nurse back and told her how upset I was, and that I wanted to have the fasting blood sugar done sooner. My 55 year old mother just developed type 2 and her mother was diagnosed at age 31 with type 1. I don't seem to be able to get a straight answer from the clinic as to what is going on. They suspect her fasting blood sugar will be within normal. However, I am still very concerned about the sugar and ketones. Do you have any suggestions or advice? Does this sound like diabetes? Do we need more information?

Answer:

You certainly need more information. Sugar (glucose) in the urine is always abnormal. I agree with your clinic’s approach including a fasting blood sugar. Also, a detailed history needs to be done by your physician. The typical signs of diabetes in children include frequent urination, excessive hunger and thirst, and weight loss. Any of these symptoms in combination with sugar in the urine is suggestive of diabetes. In confusing cases where the history and basic lab testing is not confirmatory, there are some other tests that can be done to confirm or rule out diabetes. In addition, sometimes it is best to watch over weeks or months to look for the signs of diabetes. In any case, you need to have routine follow-up with your physician to address your daughter’s needs.

MSB