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March 13, 2002

Diagnosis and Symptoms

Question from Metropolis, Illinois, USA:

We have a family history of diabetes, and I'm concerned about my seven year old daughter who was hospitalized twice last year with severe kidney infections. Since then she has been taking an antibiotic nightly to ward off the recurring infections. She had a sonogram and voiding test which were within normal limits, but she continues to bed wet three to four times weekly, is wet during the day, and has an urgency to urinate. Recently, she has mood swings, gets irritable, and is very tired in the morning and evenings. When she's tired, her eyes get very red and glassy. She is always hungry and thirsty a lot (choosing water to drink), and she has gained weight. About six months ago (at her yearly exam), her doctor screened for tested her urine for diabetes which indicated no sign of the disease. I'm not reading anywhere of a procedure to screen for diabetes with a urine test. Should I have her screened with a fasting blood sugar?

Answer:

Recurrent kidney infections are not sign of diabetes but rather some other problem. You may want to consider urologic consultation if your primary care physician and team have not figured out why these are occurring. Sometimes the bacteria are not getting totally eradicated, sometimes there are anatomic reasons (stenotic outflow tracts, congenital valves, other anatomic abnormalities of the kidneys or bladder or system, etc.).

In terms of screening for diabetes, none are terribly good. Urinalysis is an old standby, but only tells you if there has been elevated sugar levels for the previous period of time of urine collection. Fasting or random blood glucose levels are even more transient. antibody testing would be the best alternative, although expensive and usually a low yield except for research studies. Islet cell antibodies, insulin, and GAD antibodies are usually the ones tested.

SB

[Editor’s comment: Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal. See Classification and Diagnosis of Diabetes for further information.

Urine sugar tests might be positive, which would make the situation more urgent to get lab testing done to confirm the abnormal results. However, urine testing, if negative, would not exclude diabetes.

WWQ]