My 14 year old daughter has been experiencing morning nausea for a while now and has been taking Tigan for it, but it doesn’t help much. She also has frequent urination (including getting up many times at night), drinks a lot (not as noticeable as the frequent urination and it seems she has always drunk more then everyone else in the family, and has mild headaches almost every day. She has had many tests done (blood tests and CAT scan), including a glucose tolerance test to check for hypoglycemia. Her lowest reading was 60 mg/dl [3.3 mmol/L], and her highest was 177mg/dl [9.8 mmol/L]. Also, she has protein in her urine, she has passed out twice in church, and passes out on roller coasters (only those that go upside down). I don’t know if passing out at church has to do with orthostatic hypotension or not, but her doctor is concerned about high blood pressure. Last time she was sick and hardly ate anything, and when she woke up she almost passed out so we quickly gave her some apple juice. Could my daughter be in the early stages of diabetes?

Your daughter’s case sounds confusing, but unlikely to be diabetes mellitus with excessive urination due to glucose in the urine. I assume her urine has been checked for infection, and a doctor has made sure she can make less urine (concentrate her urine) if she doesn’t drink all night (has urine for specific gravity on first morning urine). I assume she is growing normally and developing normally and cortisol deficiency has been ruled out, and thyroid tests have been checked along with a complete chemistry (high calcium in the urine and an overactive thyroid can cause excessive urination without sugar in the urine). I assume kidney function tests are normal.

If all the above have been investigated and normal, you might want to consider the poorly understood inflammatory condition called interstitial cystitis. This is a non-infectious inflammation of the bladder which is difficult to treat as no one really knows what causes it. There is no specific treatment though there are medications to try. It can be associated with migraines (sometimes teens pass out with basilar migraines) and with irritable bowel syndrome and with autoimmune problems such as thyroid problems.

If your daughter haven’t seen a urologist, I would suggest she do so. An ultrasound of the bladder and kidneys and perhaps other diagnostic tests may be indicated. If the diagnosis is suspected and you are having problems treating the entire syndrome, sometimes pain specialists (especially neurologists who specialize in pain) treat this syndrome.

There are other gastrointestinal problems that can cause morning nausea such as gastroesophageal reflux which would be treated with a different medication than Tigan.

Obviously, you need a doctor locally coordinating her care and workup.

TGL