My five year old son is small for his age and is being followed by a pediatric endocrinologist for his growth, but I am concerned because recently he has been hungry all the time, and wants to eat constantly. As much as he eats, he is not gaining any weight at all. In fact, he appears to have lost some weight. He is usually a very sweet boy, but has also had periods of mood changes and is very irritable at times. Can diabetes come on slowly, or is it usually rapid, and should I be concerned about his failure to gain weight? He doesn’t seem overly thirsty, but does urinate quite a bit. Is there any correlation between a growth disorder and diabetes?

You are absolutely right to be concerned about this problem, but its solution depends on getting a careful and detailed clinical history and on doing a thorough physical exam. Growth chart information on height and weight and head circumference are needed together with appropriate laboratory support data and this includes a formal three day dietary analysis irrespective of final diagnosis.

All this is obviously beyond the scope of an e-mail so I think you need to speak with your son’s endocrinologist and find out whether simple tests for conditions like diabetes, which seems unlikely, and hypothyroidism have been carried out and what exactly the plan is for a final diagnosis. If this is not convincingly forthcoming, you need to find another pediatrician.

DOB