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April 30, 2001

Diagnosis and Symptoms

Question from Littleton,Colorado, USA:

My best friend' s 22 month old daughter was diagnosed with diabetes yesterday. She went in for what her mother believed to be a UTI [urinary tract infection], which she did have. When checking her urine for bacteria, they found sugar and did a blood test which was 225 mg/dl [12.5 mmol/L]. A urine ketone test was also positive. After seeing a pediatric endocrinologist, they have been sent home to monitor blood sugar and urine ketones three to four times a day for the next three to four days. Today, the blood sugars have been normal and there is no sugar or ketones in the urine. The baby has never had any of the other classic symptoms of diabetes. Has there ever been a case of ketones found in the urine one time and the child does not have diabetes?

Answer:

Ketones only mean that there is fat being metabolized. Ketonuria (ketones in the urine) or ketonemia (ketones in the blood) alone is not diagnostic of anything. Diabetes is diagnosed based upon blood glucose levels and not urine glucose levels.

Coupled with high sugar levels, ketonuria and ketonemia usually indicates insulin deficiency, but several types of infections can also cause glucose and ketones in the urine, as well as elevated blood glucose levels. Sometimes this is a transient phenomenon.

This child’s parents need to be in close contact with a pediatric endocrinologist who can help decide if this is a transient elevation of blood glucose versus an early manifestation of diabetes. Sometimes, antibody tests will be helpful, but often are not in a very young child. Hemoglobin A1c may also be useful to monitor sequentially.

SB