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July 13, 2017

Diagnosis and Symptoms

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Question from Jeffersonville, Indiana, USA:

My son is two and we suspect he may be diabetic, maybe prediabetic. On Friday, June 23, I made him an appointment suspecting a UTI because he had been urinating SO much over the past few weeks, about two diapers every hour on the worst days, one every 1.5 hours on good days, plus trips to the potty (awake hours). Until five weeks ago, he was wetting five or six diapers during awake hours. On Monday, June 26, they did a urine test and it was fine. The following day, he had a BMP (basic metabolic panel) and sugar and ketones were in normal range. The doctor is still suspicious and didn’t say he was ruling out anything just that, right now, his blood work is showing everything is normal. He suggested we keep a close eye on him for a fee weeks and try to give him less to drink. When his cup is empty he will seek out any source of fluid he can-dog bowls, bath tub, sink, water bottles, and even tried the toilet. He’s also incredibly restless, has a very hard time sleeping, seems tired often, gets very irritable, especially when he’s hungry. He was almost 11 pounds at birth. I did not have gestational diabetes but his blood sugar was around 30 mg/dl [1.7 mmol/L] when he was born. My sister died from DKA and there’s history of type 1 and type 2 on both sides.

Answer:

The excessive urination and normal thirst response to the excess urination, as you described, is not normal. Stay in close contact with your medical team and perhaps consider doing some home blood glucose monitoring that they can teach you (or some of your family members who do this already). The newborn low blood glucose is not an issue at this age but might reflect his large initial birth weight. If all the blood glucose levels are entirely normal (<99 mg/dl [5.5 mmol/L] before meals and <130 mg/dl [7.3 mmol/L]after meals), then there is another kind of diabetes, called DI or diabetes insipidus, that needs to be considered. This involves a problem with a pituitary hormone called ADH that controls urine volume and would cause such symptoms without high sugars being causative. Urine specific gravity would be very diluted with DI. Also, weigh your child once or twice-a-day since weight loss would also be worrisome and indicate that he was not able to keep up with his fluid needs from the excessive urination, is at risk of getting dehydrated, etc. If the symptoms get worse or persist, then call back the medical team for a re-evaluation. SB