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December 7, 2006

Diagnosis and Symptoms

Question from Fairless Hills, Pennsylvania, USA:

My daughter has had chronic UTIs for about five months. She has excessive thirst, frequent urination, nighttime wetting, and gets really tired when she has something sweet. She has had many urinalysis tests done but, every time, she has never had ketones or glucose in the urine. I checked her sugar one time with a fingerstick before she ate and she was 165 mg/dl [9.2 mmol/L], which I thought was pretty high. When I mentioned it to the urologist and pediatrician, they said, "Oh well, she has never had any ketones so we will test her one time and see what it is." He blood sugar was 107 mg/dl [5.9 mmol/L]. They never tested her again and she is still not getting any better. Can someone with diabetes never have any ketones or glucose in the urine? Should I ask the doctor to test her again?

Answer:

A child that is developing diabetes may have intermittent glucose in the urine. Urine testing is not a reliable test for diabetes. In addition, ketones in the urine in a child that is developing diabetes can be an ominous sign of impending diabetic ketoacidosis. It is far preferable to diagnose diabetes prior to developing diabetic ketoacidosis, if possible. There are several blood tests that can assist with the diagnosis of diabetes. A board certified pediatrician should be familiar with these tests — and may suggest them, in addition to a thorough history and physical examination. Please consult with a board certified pediatrician.

MSB