March 1, 2004
Behavior, Diagnosis and Symptoms
Question from Daphne, Alabama, USA:
My stepdaughter wets her pants while awake and has gained a lot of weight in the past year. She is now 11 years old and weighs about 160 pounds. She has seen both our family doctor and a urologist, both of whom found nothing wrong physically. The urologist ordered a nuclear sonogram which showed everything in working order. She has a half-sister with diabetes who started gaining weight, then losing, and wound up in the hospital with a sugar level of 800 mg/dl. She now has an insulin pump, but is still not doing well. Their mother doesn’t take them to the doctor regularly, but we do take my stepdaughter when she is with us. No one, to my knowledge, has tested her for diabetes. Do I need to push this issue, or take her to a specialist? Her urine has a very strong odor. I am at my wits end as to what to do.
Your stepdaughter presents a number of health problems. In the first place, she weighs some 30 pounds over the 90th percentile for her age and, as such, is almost certainly obese rather than just overweight. This, combined with inactivity, puts her at substantial risk for type 2 diabetes, which has become a significant problem in childhood. Finally, there is the possibility that psychosomatic issues related to her divided home play a role in her urinary incontinence. The most urgent task is to make sure that she is not already glucose intolerant, which can be done by occasional fasting or random blood sugar tests. Urine glucose testing is much less expensive when here is no one with diabetes already in the home who is familiar with monitoring, but, it is much less reliable, albeit better than no testing at all. I do not, however, think that a more elaborate glucose tolerance test is indicated and I assume that the urologist ruled out a chronic urinary tract infection. The weight problem is a very hard one indeed. In theory, of course it just requires a reduction in calorie intake with advice as to how this can be achieved safely. The plethora of programs, though, is a small indication of how very difficult indeed this is to achieve. Nonetheless if there is a weight reduction program for young people available through a nearby children’s hospital for example, it would help for her to be enrolled even though the long term prospects are very disappointing. A lot however is now being learned about the hormonal control of appetite and it seems possible that in a few years that this problem will be approachable more scientifically through making changes in the secretion and effectiveness of hormones like ghrelin, leptin and PYY3-36. Bariatric surgery is also coming to be recognized as a possible approach even for teenagers.
The help of a clinical psychologist or a Medical Social Worker might, if it were possible, be a great help in trying to disentangle and remedy the possible emotional content to her incontinence and weight problems.
Additional comments from Brenda Hitchcock:
You can read more about diabetes at our Diabetes Basics page. If your stepdaughter is able to use her half-sister’s glucometer to test her own blood sugar, you can determine what her blood sugar means by reading Classification and Diagnosis of Diabetes. Keep in mind that laboratory blood sugar readings are more accurate in diagnosing diabetes.