Question:
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?
Answer:
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.
TGL
Original posting 15 Mar 97