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July 17, 2009

Diagnosis and Symptoms

Question from Fort Worth, Texas, USA:

I have a two-year-old son who drinks a lot. He will literally stand at the refrigerator and drink from the water dispenser if we don't lock it or drink any drink left on the table if it is not removed. He is very small for his age and has been diagnosed with failure to thrive. He currently drinks Pediasure two times a day, but if he is taken off of them, he stops gaining. He to my knowledge, he shows no other signs or symptoms of diabetes except the thirst. I have recently been diagnosed with diabetes so I have a glucose meter at home and started to monitor his sugars. His fastings have ranged from 99 mg/dl to 110 mg/dl [5.5 to 6.1 mmol/L] with most being over 99 mg/dl [5.5 mmol/L]. He did have a low one of 78 mg/dl [4.3 mmol/L]. One of his fastings was 91 mg/dl [5.1 mmol/L] and we had a late breakfast. I checked him before he ate and his blood sugar was 130 mg/dl [7.2 mmol/L]. He has also had some elevated blood sugars after eating. They ranged anywhere from 125 mg/dl to 185 mg/dl [6.9 to 10.3 mmol/L] two hours after eating. I also tested one hour after eating and he was 217 mg/dl [12.1 mmol/L]. He has had a urine test with no sugar or ketones in his urine and a fingerstick at the doctor's office which was only 99 mg/dl [5.5 mmol/L]. I know my meter is calibrated and I also compared it to another meter I have and they were close by a couple of points. Do toddlers have different blood sugar values and that's why the doctor doesn't seem to worry or should I get further testing?

Answer:

Toddlers do not have different “normal glucose values” than adults. Certainly, the majority of your son’s glucose readings are not bothersome, but a couple of them raise a bit of an eyebrow.

Ask your son’s doctor to perform a fasting 8 a.m. serum chemistry profile (this is a “real” needle stick into a vein) before the child has had ANYTHING to eat or drink that morning. That means NO water, too. This chemistry profile should include glucose, sodium, calcium, and osmolality. Furthermore, you should collect the boy’s first morning urine sample (in the proper container from your doctor or pharmacy) to measure for glucose, specific gravity, the ratio of calcium-to-creatinine, and osmolality.

You apparently have only noted increase in your son’s thirst, but not an accompanying increase in urination. I’d suggest that as best you can, start to TRACK and MEASURE the volume of liquids taken in during the day and TRACK and MEASURE the amount of urine he pees. (This may require attaching a urine collection bag on a toddler, if he’s not toilet trained. You can get these from your doctor also.)

Not all conditions that lead to excessive thirst are related to diabetes mellitus. Has your son experienced an injury to his head? Is he on medications? Your doctor should screen for these other conditions. One confusing condition has a confusing name called “diabetes insipidus,” which has nothing to do with glucose. If your doctor comes up empty after the above, s/he may request a referral to a pediatric endocrinologist. The combination of excessive thirst and “failure-to-thrive” brings to mind some important considerations.

Good luck and please let us know.

DS