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July 3, 2001

Behavior, Hyperglycemia and DKA

Question from Chicago, Illinois, USA:

My friend's three year old was diagnosed with diabetes, and at that time, he was almost completely toilet trained, but now he has regressed and is in Pull-Ups. He is now three and a half years old and is running some very high blood sugars. Do the high blood sugars affect his ability to toilet train?


Yes, it definitely can affect the ability to toilet train. As the blood glucoses are more in control and the child is a little older, all should work out. Your friend should not force the issue.


[Editor’s comment: It is not only the high blood sugars that can affect toilet training, the diagnosis itself may be part of the problem. When a child this age is diagnosed with any chronic illness, they think they are being punished and will often regress to stage when they did not have the problem. This child may somehow associate toilet training with diabetes and think that if he is no longer toilet trained, his diabetes will go way. This is normal behavior and does pass over the course of time.

The first step, as Lois has suggested, is get the blood sugars more in control so that the need to urinate so often and so much is diminished. Secondly, even with the elevated blood sugars, your friend should not abandon the toilet training. She needs to offer the potty frequently (perhaps even every hour or so), reinforce using it, and not focus on “accidents.”

A child psychologist may be of benefit for both mother and child in sorting out the complexity of issues involved.