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April 19, 2001

Diagnosis and Symptoms

Question from a nurse in Mitchell, Indiana, USA:

My two year old nephew has always drank a lot of fluids, complained of thirst and frequent urination, and he gets up usually once, sometimes twice, a night to urinate. Last week he fell in the floor while walking to the bathroom, and the babysitter thought he may have had a seizure, he had felt bad all day. He does have congestion and a cold. I did a fingerstick blood sugar which was 115 mg/dl [6.4 mmol/L] that evening and the next morning's fasting was 149 mg/dl [8.3 mmol/L]. My nephew's pediatrician examined him, did a urine dipstick which was negative for glucose, and told my sister was told that a child's glucose can rise during an illness. Since he was not spilling glucose in his urine, he does not have diabetes. While I hope this is true, shouldn't some lab work be performed? Is the urine dipstick diagnostic enough? My sister thinks I am interfering, but I am an RN, and I am too worried to let it drop with a simple urine test. I thought that in order to spill glucose in the urine you had to reach a threshold level that can be higher people with diabetes. I have read that diagnosis is two separate fasting glucose levels of 126 mg/dl [7 mmol/L] or higher. Can a child's be higher during a cold?


This type of problem is common. I would agree with the paediatrician. Stress can cause the blood sugar to rise. This wouldn’t normally be associated with symptoms of thirst and frequent urination, but toddlers often drink a lot of juice.


[Editor’s comment: I would suggest that, once your nephew is over his cold, and if his symptoms persist, you encourage your sister to take him back to the pediatrician for a fasting blood glucose followed by a large breakfast and a repeat blood glucose two hours postprandially.