April 14, 2014
Diagnosis and Symptoms
Question from Kansas, USA:
My four-year-old son has always been a drinker. He always seems to want a drink in his hand from the time he could ask for one! The first thing he does when he wakes up in the morning is ask for his strawberry milk. I was never concerned about this but, over the last couple of months, I have noticed that he has had more frequent urination; his sitter even mentioned it to me. We do notice it more in the evenings. I noticed his underwear of basically falling off him recently though I have not weighed him. He also has had some changes in the way his breath smells. When he comes home in the evenings, he usually asks for a drink and to lie down in our bed to watch some t.v. He will just relax, seeming to be tired, for an hour or so. I have a working relationship with my child’s doctor so I mentioned it to her and she ran some laboratory tests about a month ago, a fasting blood sugar (CMP), CBC and TSH. His sugar was 89 mg/dl [4.9 mmol/L]. He did have a slightly elevated ALP – 254, creatinine low at 0.3 and BUN to creatinine ratio at 45.5. She was not concerned about his results. I trust her opinion. I spoke with her again last night because he had to urinate three times within an hour on a trip we took and I just couldn’t ignore it. However, today has only urinated a few times. She said that we would do a 3 hour glucose tolerance test. Should I ask her if she will run a urinalysis? I don’t want to be pushy but it seems to me that would be one of the first things that would be ordered. We have a strong family history of diabetes on both sides of the family, including juvenile diabetes (type 1) on the maternal side. I guess I am just at a loss of what to do, I don’t know if I am overthinking all of this? Is it possible with diabetes that he would excessively urinate one day and, then, another day not?
Answer:
Diabetes would have high blood glucose levels and so may show up as excessive thirst and excessive urination. Urine via urinalysis would have sugar (glucose) and sometimes ketones present. Checking blood glucose levels several times cold provide some added information. Formal glucose tolerance testing is usually not needed. Another test that gives a longer term look at how high the sugar levels have been is an A1c and this is also quite easy to obtain. GAD, islet cell and other pancreas antibodies also may provide some information, if positive; if negative, they may just be insensitive especially in very young children. It is also important to eliminate other possible explanations for the excessive thirst and excessive urination, i.e., diabetes insipidus where the pituitary hormone vasopressin is not available. Then, the urinalysis would show very diluted urine (low specific gravity) and there may also be sodium salt abnormalities as well. Rarely, thyroid problems or adrenal cortisol problems can also masquerade as odd urination and thirst problems so these too may be checked. Most importantly, go back and ask these same questions to your pediatrician so that more detailed information can be decided upon for checking.
SB
