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Question:

I have a 2 year 9 month daughter who had been potty-trained for about 3 or 4 months. She suddenly started to have a lot of accidents, both day and night (as many as 5 in one 24-hour period). These accidents were upsetting to everyone, and were disconcerting me. I thought it might be a bladder or UTI, so I called the pediatrician to discuss it and ask for hints/ideas related to the numerous accidents. The pediatrician ordered a urinalysis and culture. The urinalysis showed sugar. The pediatrician called my husband and me at work to tell us to take our daughter to the hospital for additional testing and possible admission.

Subsequent tests showed no signs of diabetes. They did another urine test and a blood test. As far as I know they only did a blood glucose test on the rapid meter in the emergency room, and sent some more blood to the lab. They did not mention if they'd done any other lab tests such as C-peptide or HbA1C.

She was fasting from lunch time to 9 P.M. before the blood sugar was taken. Could this give an inappropriately low blood glucose reading? She was without beverage from lunch time to 6 PM when the 2nd urinalysis was done; she had gone to the bathroom several times in the meantime. Could this have given a false reading of 'no sugar'?

The doctors at the emergency room, and her own pediatrician, say that it didn't matter that she'd been without food or drink since lunch time at child care until 6 PM (urine test) or 9 PM (blood test). They say that for diabetes in such a young child it would be Type 1 and her body would have shut down insulin production. They say that this means that her blood glucose, fasting or well-fed, would have been high. It was only in the 70s (mg/dl? I forget the unit).

We see no other signs of Type 1 - no excessive thirst or excessive urination, weight loss, mood swings, excessive tiredness, thrush. Occasionally her stools are black, but it's infrequent.

The emergency room personnel at the children's hospital consulted with the endocrinologist and our daughter's pediatrician. It was 11 P.M., but we were finally sent home with no clear explanation and no diagnosis of IDDM.

Our pediatrician called and said to keep an eye out for symptoms, call back if the potty accidents in a trained child persist.

Should any other tests be performed to rule out IDDM at this time? Would a C-Peptide or HbA1C give us any additional information? Does sugar in the urine indicate other things? What could be an explanation of a positive sugar in the urine once, with no subsequent signs of IDDM?

I feel an error on the first test or a miracle cure are likely explanations. However, I worry that there are other explanations, too. Perhaps she's in the very earliest days of Type 1? Perhaps we are seeing the signs of Type 1 that other people might never notice?

I'll be grateful if she's not ill with diabetes. But I'd like to catch it in the earliest stages if possible, if indeed she gets diagnosed with Type 1.

Answer:

It may have been that the original test was a false positive, perhaps contaminated, but it is no unusual to find small amounts of glucose in urine in young children on occasions. If it were diabetes, the blood glucose should have been higher than normal. However, in very early stages, the results may be normal after a fast. If you have any concerns, get back in touch with your paediatrician and ask for a review of the problem. However, remember that if your child is well, do you really want to subject her to tests which in the end may not be necessary? It sounds like your child is fine, and is not likely to have diabetes form the story. However, get reassurance from your paediatrician.

JS

DTQ-19991010134517
Original posting 3 Dec 1999
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:06
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