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Question: From Delavan, Wisconsin, USA: I have had a triage nurse at my local clinic suggest that my 11 month old daughter should be tested for juvenile diabetes due to her increased need for water/breastfeeding and frequent urination. My daughter also seems to have an increased appetite (which I am concerned may be related to her thyroid), that I dismissed as a growth spurt. My question is two parts: 1. How early can type 1 diabetes present itself? 2. How do they test a child under/around one year? She does have risk factors for diabetes. Both myself and her father have diabetes. I am diet controlled and my husband is on pills and checks his sugar four times a day. I also have an autoimmune thyroid deterioration disorder. I am just curious how to approach this situation. Answer: Type 1 (insulin requiring) diabetes mellitus can present as early as a brand newborn! But, that is rare and due to an unusual chromosomal disorder. How do you screen an 11 month old? The same way you screen ANY patient: with a serum glucose. I think it would reasonable to screen the baby with a fingerstick glucose as your spouse is doing. I would not DIAGNOSE diabetes based on a fingerstick but it should help as a screen. A high fingerstick glucose should be confirmed, perhaps with a FASTING SERUM level from blood from a vein and run in the laboratory of your hospital or clinic. While type 1 diabetes mellitus can occur at any age, there are peak incidences at about first grade, sixth grade, and between ages one and two. But, infants with type 1 diabetes are usually obviously ill! They urinate much, but don't gain weight and quickly deteriorate. If someone urinates and drinks a lot, you have to distinguish the old riddle of "which came first: the chicken or the egg?" By that, I mean, is the urination a primary consequence of something going on in the kidney (e.g., flushing out extra glucose because of diabetes) for which the increased thirst is a compensatory mechanism to prevent dehydration? OR, is there a primary intake of excess fluids/thirst for which the increased urination is a compensatory mechanism to prevent being fluid overloaded? Simple simultaneous urine and blood collections often can help distinguish. Type 2 diabetes (the type treated often with "diet and oral agents) would be virtually unheard of in an 11 month old infant. Given what you have written, I doubt your child has diabetes mellitus, but you should not ignore the concern of your health care provider. Let us know what you learn. DS DTQ-20061117131113 Original posting 5 Dec 2006 Posted to Diagnosis and Symptoms

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Last Updated: Tue Dec 05 17:37:30 2006
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