From Charlotte, North Carolina, USA:
My seven-year-old daughter has issues with wetting her bed and also during the day. I have always noticed a weird smell with her pull-ups in the morning. Urology has cleared her saying it is a developmental issue and seemed unconcerned about the smell. She was diagnosed with ADHD and is on Concerta. While her behavior during the day has improved, she has rages both morning and evening. She also does not eat well during the day and complains about being hungry all the time, often eating twice in the evening. Lastly, she has chronic dry skin and scratches constantly. Her father has diabetes and I had insulin dependent gestational diabetes while pregnant with her. I am beginning to wonder if all these things have a link to diabetes and not the ADHD. What do you think?
In a child, the most common symptoms of diabetes mellitus (in physiologic order) are an increase in urination (usually large volumes and frequent bathroom trips) and an increase in thirst (as a compensation mechanism to overcome all the fluid losses because of the increased urination). In adults, there is often an increase in hunger as well; in my experience, children with diabetes mellitus (especially type 1 diabetes) often present with diminished appetite. Increased appetite can occur in children with diabetes mellitus, no doubt, but in my experience, the increased hunger is often overlooked by parents but they do notice when the child's appetite diminishes when the child begins to develop ketones in their systems. Ketones are by-products of using body fat for fuel. Ketones can give the urine (and breath and sweat) an odor (often described as "fruity" but I never have thought of the smell as "smelling of fruit.") On the other hand, many, many things can cause the urine to have an odd variety of odors. I'm not sure I understand your description of your daughter that she "does not eat well during the day" yet is "hungry all the time," as this seems contradictory and, as such, would not be terribly consistent with diabetes mellitus. Decreased daytime appetite may certainly be a side effect of a morning dose of the Concerta. Often, when such psychostimulant medications wear off at the end of the day, there is a "rebound" increase in appetite. Perhaps that is what you are describing.
At age seven, a small percentage of children still do wet the bed at night, so your daughter's need for diapers/Pull-Ups is not too worrisome; yet you indicate there is daytime wetting also. If this is a NEW symptom, then I would be that much more concerned about some acquired condition, such as diabetes mellitus. But if this daytime wetness is longstanding, then I would be less concerned about diabetes mellitus because children with diabetes mellitus tend to get very ill rather quickly with dehydration, ketones, vomiting and other symptoms. Furthermore, the reason the person with diabetes mellitus urinates so much is because there is an abundance of glucose in the urine being excreted. If your daughter has had increased wetting long enough to be seen by a urologist, I can't imagine that a urine sample hasn't been analyzed. If she has diabetes mellitus, one would anticipate glucose to have been found in the urine (although that admittedly can vary, depending on the degree of any elevation in blood glucose).
There certainly are other conditions that can lead to increased urination (and thirst) that do not have anything to do with blood glucose. Some have confusing names (such as "diabetes insipidus") or are associated with irregular levels of calcium in the blood or urine or irregularity in thyroid levels; there is a long list of conditions.
I would advise that you make an appointment with your general pediatrician to discuss your concerns. It is easy to test a child for diabetes mellitus. But if your daughter is not making large amounts of urine and simply "leaks" during the night or day, then a developmental issue or spasmodic bladder (or something similar) might be the correct diagnosis and is usually fairly amenable to treatment.
Let us know what you learn.
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