My 8 year old son started drinking a lot and urinating a lot about three to four weeks ago. Two weeks ago, he started wetting the bed several times a night. He also has begun chewing on his shirt collar. I took him to the pediatrician and he did a urine test. The test showed no sugar. The doctor grew it out to test for infection and that was negative as well. We went last week since my son is still drinking a lot, up to six times an hour, and urinating a lot, including wetting the bed. He drinks mostly water. The doctor didn’t seem concerned last week and when I asked what to do if this keeps up, he just told me to let him know.

Can a child have diabetes if the urine showed no sugar? Is there a blood test that might be better at picking it up? Can all this be pre-diabetes signs? The doctor did say to try to get him to drink less, but my son tells me his throat feels really bad and he has to drink. He says he chews his shirt and swallows the spit.

There are several things that could cause a child to urinate more and be thirstier. Sometimes, the correct answer depends on which came first, the chicken or the egg: Is the child primarily drinking more and is therefore urinating more in order to prevent fluid overload OR is the child primarily urinating more and is therefore drinking more in order to try to prevent dehydration? In typical diabetes mellitus (“sugar diabetes”), the answer is that the excess glucose sugar is leading to increased urination and thus a compensated increased thirst to prevent dehydration. Another condition with a similar sounding name, called “diabetes insipidus” can lead to the same symptoms, although has nothing to do with sugar. This has sometimes erroneously been called “salt-diabetes.”

It is also possible that the urine dipstick test in the doctor’s office may not have been fresh and thus gave a wrong answer.

I would say that is not at normal for an otherwise well child to suddenly have a change in the bathroom and thirst habits and this should be explored. So, I would suggest that you maintain your dialogue with your pediatrician and recommend that you have a blood test for glucose sugar and appropriate blood and urine tests for diabetes insipidus done. This might include what is sometimes called a “basic chemistry profile” in the blood and “urine specific gravity” in the urine as initial screening tests.

There are MANY things that can change the body’s fluid dynamics. A referral to a specialist may be warranted if your primary care team cannot or will not find an answer.

DS