From Plano, Texas:
Our 11 year old son has been diabetic since age four and a bed wetter since around that time. We have tried various therapies including, cutting off liquids after 7 P.M., getting him to the bath room in the middle of his sleep, "wake-up mats", counseling, and, more recently, DDAVP. None of these therapies seem to help and our son still lives with the pain of enuresis. His HgA1C's have been around 7.8 for the last year and he is under good control, testing himself 7 or more times per day. He is on a constant carb diet with 75 grams for each meal and 30-35 grams for three daily snacks. His insulin is as follows:
Before Breakfast: 11 NPH and 2 Humalog Before Dinner: 4 Humalog Before Bedtime: 9 NPH
We are as frustrated as he is about this and are willing to try any safe and reasonable course of action to help him with this problem. His family is very supportive and many of his friend's parents know about this and support him regarding sleep-overs.
What can we do? Is this diabetes related/aggravated?
Bed wetting can persist at this age even in children without diabetes (especially boys). Often there is a family history of late nighttime training. I assume your son does not urinate excessively during the day and that you have checked his blood sugars during the night to make sure they are not unusually high (any increase in blood sugar above 200 may exacerbate the tendency to enuresis). I also assume his thyroid function is normal. (Children with diabetes are more prone to developing an overactive thyroid which can cause excessive urination.) Very rarely, children with Insulin Dependent Diabetes Mellitus may also have Diabetes Insipidus (a deficiency of ADH, a hormone that helps decrease urine volume). DDAVP is a synthetic form of ADH, so if he doesn't respond to this and doesn't urinate excessively during the day, this is unlikely.
If you have ruled out all the above, I suggest you continue to work with your pediatrician and/or a pediatric urologist to try and control the problem. Often reassurance that the child is "normal" and will outgrow the problem with time can go a long way in helping these children cope with this embarrassing problem.
Original posting 15 Mar 97
Last Updated: Tuesday April 06, 2010 15:08:52
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