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From Montana, USA:

My 10 month old son has been experiencing growth problems for 6 months now. My pediatrician believes he may have Renal Acidosis. He tells me his glucose levels in his urine are fine, but my son experiences a lot of the symptoms of Type 1 diabetes. He urinates very frequently, and breastfeeds at least 16 times a day. He has been eating solid/table foods for 3 months now, showing an increased appetite (nursing has not slowed -- it has increased). What tests should my doctor be performing to rule out diabetes? Is it possible to have an early stage of diabetes without high blood sugar levels in the urine? We are desperate to find an answer to why he is not growing. He weighs 13 pounds and has since he was 4 months old. Thank you!


The symptoms of diabetes mellitus -- increased thirst and excessive urination -- are due to glucose in the urine. In diabetes mellitus, the excessively high blood sugar is removed from the body by the kidney and appears in the urine causing excessive urination. The excessive urination leads to loss of water from the body triggering thirst. If there is no glucose in the urine when your son is having these symptoms, he does not have diabetes mellitus. (There are also disorders with sugar in the urine but normal blood sugar because the kidney inappropriately "spills" sugar in the urine even though the amount of sugar in the blood is normal. This is called renal glycosuria. If the blood sugar is normal when sugar is in the urine, the child does not have diabetes mellitus and does not need insulin.)

If your son is not growing or gaining weight, he needs a complete evaluation to look for the cause. It is difficult to assess excessive urination and thirst in a child who is breast feeding and in diapers (that doesn't mean your child doesn't have excessive urination and thirst, it is just more difficult to document in this situation.)

Renal tubular acidosis can definitely cause growth failure in an infant. This can occur as an isolated problem with the kidney, part of a more generalized kidney problem, secondary to damage to the kidney by metals such as lead, or part of more generalized disorders. Cystinosis is one disorder in which renal tubular acidosis can occur along with difficulty concentrating the urine leading to excessive urination and thirst.

I strongly suggest that you consult with a pediatric kidney specialist (pediatric nephrologist). If no kidney problem is found and your child is not growing or gaining weight, you should consult with a pediatric endocrinologist.


Original posting 13 Jun 97


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