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December 22, 2008

Diagnosis and Symptoms, Other

Question from Penicuik, Midlothian, United Kingdom:

My child has only had diabetes for six months, so it is still new to us. She has started to wet the bed again and is drinking a lot. Her blood sugar readings are high then really low, especially at bedtime which is when she has started wetting the bed. I'm concerned about this.

Answer:

You sound frustrated, but I’m afraid that I am unsure of what you are really asking. But, if I surmise correctly, the main answer you want should be focused as to the reason your daughter is having bed wetting again.

Given that she has diabetes, then that is probably the center of the issue. You describe that she is drinking a lot and that her glucose values fluctuate from high to very low. You did not indicate the insulin and meal regimens that you try to set for your daughter. Once the blood glucose level is about 180 mg/dL [10.0 mmol/L] or more, the kidney can no longer re-absorb all the glucose and some of that glucose goes through the kidney “filter” and “spills” into the urine. Glucose tends to pull water with it. So, the more glucose the kidneys see, the more water must be filtered to keep the glucose dissolved. If this didn’t happen, we would urinate “clumps” of sugar. Passing a sugar cube would be painful, wouldn’t it? I would be inclined to say that her increased thirst is to compensate for all the water that is being lost through the kidneys.

So, although your daughter has been diagnosed with diabetes for only six months, I’d guess that her overall glucose control is rather inadequate right now.

Look for patterns in her glucose levels. Does she tend to be higher at specific points of the day? How do you treat them? Are there ketones present? When do you check for ketones? How do you treat her low glucose values? Could you be “over”-treating? Take these questions, and your answers to these questions, to your own pediatric diabetes healthcare provider and ask for assistance. If you are not being assisted by a pediatric endocrinologist, there must be a way that you (or your daughter’s doctor) can confer with one.

Do other conditions exist that can cause a child to have some relapse in bed wetting? Sure, but most are not associated with increased thirst and none are a reflection of higher glucose readings. There is a sort of saying in the U.S.: Why did the bank robber rob the banks? Because that is where the money is. In someone who has diabetes and is having symptoms referable to their diabetes, I’d focus in on her diabetes control.

DS