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February 22, 2009

Diagnosis and Symptoms

Question from Long Island, New York, USA:

Is it possible for a child to be in a honeymoon phase without an actual diagnosis of diabetes? My daughter was exhibiting high blood sugars, thirst and occasional excessive urination. By the time I realized something might be wrong and took her to the pediatrician and an endocrinologist, she was stable. Her symptoms wax and wane, but are fairly good right now, so she was not diagnosed. I feel like I'm crazy, that things just "went away" but I know that the previous symptoms WERE there (as does my sitter and mother). Can a person (child) go into a honeymoon phase without having been treated with insulin or is that only something that occurs after having been treated with insulin? I'm just trying to decide if I should back off on the testing. I do plan to resume testing if/when my daughter is symptomatic.


No doubt that the most common symptoms and signs of diabetes mellitus include increased thirst and urination. Unfortunately, those symptoms are not unique to diabetes mellitus.

When noting that a child’s bathroom habits have changed in the manner you describe, the key is to discover which came first, “the chicken or the egg.” Is the child primarily urinating more and then drinking to compensate for all the fluids lost (as in diabetes mellitus and several other conditions)? Or, is the child having a primary increase in thirst/drinking excessively and then urinating away the excess fluids (in order to avoid being water-overloaded)? It is hard to distinguish these from simple recall. Very simple and inexpensive urine and blood tests can greatly assist.

Was the child taking any other medications at the time you noticed the symptoms? Had there been any notable trauma to her head?

The fact that the symptoms self-resolved is certainly encouraging. Most of the primary increase in urination with compensating increased thirst conditions are not self-limiting.

Could this be a veiled diagnosis of diabetes mellitus and honeymoon? I doubt it. I can’t recall ever experiencing a patient with type 1 diabetes and a “built in” honeymoon, but I have seen atypical presentations of type 1 when symptoms seemed to percolate irregularly. What are her risks for diabetes mellitus? If there are significant risks, especially a very strong family history, your doctor might wish to consider carefully a PROPERLY done oral glucose tolerance test (OGTT). But, before I would go that direction, I might watch a little longer and if symptoms seem to recur, perform a simple first morning urinalysis (which checks routinely for glucose) with microscopic examination and assessment for excess urine calcium-to-creatinine. Then, perhaps, the doctor should do a simultaneous, first morning venipuncture for some routine serum chemistries, including glucose, all done fasting, before the child has had anything to eat or drink after awakening. Your general pediatrician could arrange these; they shouldn’t do the OGTT without oversight of the pediatric endocrinologist to be sure it is done most correctly.