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February 27, 2007

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Question from Portsmouth, Virginia, USA:

My three and a half-year-old daughter was diagnosed with diabetes eight months ago. She has been potty trained through the day for well over a year now. We have not been able to get her to stay dry through the night. Most nights, she runs in range, 100 mg/dl [5.6 mmol/L] to 200 mg/dl [11.1 mmol/L], but some nights, she's very high, mid-200s mg/dl [13.5 mmol/L] to 300s mg/dl [over 16.7 mmol/L]. She has always required a lot to drink, even prior to her diagnosis. I am having trouble discerning if this is directly related to diabetes or if I'm giving too much drink during the evening. If I need to cut out drink before bedtime, how can I know that her thirst is not related to diabetes, in which case, I should give her something to drink?

Answer:

Your question is very practical.

The kidneys tend to “spill” glucose into the urine once the blood glucose is about 180 mg/dl [10.0 mmol/L] or higher. This extra glucose in the urine must be excreted with water (after all, she can’t urinate a “sugar cube”). So, as you know, the higher the glucose, the more urination. And, with increased urination WITH RISK OF DEHYDRATION, comes increased thirst.

So, if “most of the time” the nighttime glucoses are over 180 mg/dl [10.0 mmol/L], then I’d be pressed to say that at least SOME of the nighttime wetting is due to diabetes.

Is there any harm to bed wetting? Apart from social concerns and lots of laundry and the occasional diaper rash, probably not too much. Many three-year-olds (and older) aren’t completely dry at night. But, many are.

I’d suggest you work with your diabetes team to aim to get the nighttime glucoses in lower ranges. I wouldn’t, with diabetes mellitus, restrict access to fluids.

DS