Diabetes or just Normal Thirst?

Dr. Greene, my 2-year-old daughter drinks a lot during the day. It could be water, juice, milk, or whatever. I am concerned. Is this normal for kids to drink 5-8 bottles of liquid during the day? Or this is a sign of diabetes? Should I bring her in for a test? Are there any other signs I should be looking for?
I am really concerned.
Thank you.
Irina Eilen – The Gap


Dr. Greene’s Answer:

Irina, just last week on Monday morning, I picked up the top chart from my inbox and began walking to Exam Room 1 (the Safari Room). Before opening the door, I paused to open the chart and glance at the nurse’s notes. I was about to meet a 7-year-old boy whose mother had brought him in because he had been drinking much more than usual for about 2 weeks — especially over the preceding weekend.

I stepped in the room and greeted the mother and son. They confirmed what had been written in the chart, adding that he had also been urinating much more than usual, and perhaps had lost some weight. As they spoke I could tell that the mom felt a little guilty about bringing him in unnecessarily, but at the same time she was worried that something might be seriously wrong. Parents often experience this dilemma. Whenever you are battling inside about whether to contact your doctor, do it.

The boy’s clothes were indeed loose fitting, but he otherwise appeared healthy. We did a simple urine test in the office, and two minutes later found that he had a huge amount of sugar and ketones in his urine. He had diabetes.

Even though the mom suspected the diagnosis, she was totally stunned. She couldn’t believe it was true. I sent them across the parking lot to the hospital lab for some bloodwork. His blood sugar level was 645 mg/dL! A fasting blood sugar over 126 mg/dL or a random blood sugar over 200 mg/dL is diagnostic of diabetes, according to the official American Diabetes Association definition as of June 23, 1997.

I admitted the surprised boy to the Packard Children’s Hospital at Stanford for the whole family to learn a new way of life with type 1 diabetes mellitus.

Now, Irina, I must reassure you that the first part of the above scenario is played out in my office about every two weeks. A child is brought in for nothing more than drinking or urinating more than usual. The weight and physical exam are normal, and I run a urine test. Thankfully, the test is almost always normal, and everyone can take a deep breath and relax.

About once a year, though, I diagnose someone with diabetes mellitus. The name comes from the Greek words for “to flow through” and “sweet.” The Greek physicians used to diagnose the condition by actually tasting the urine. (That’s dedication!).

Normally, a hormone called insulin pushes sugar from the blood into the body’s cells where it can be used for fuel. The concentration of sugar in the blood remains within a fairly narrow range. If the body stops making insulin (type 1 diabetes), then adequate sugar doesn’t get into the cells. Until June 23, 1997, type 1 diabetes was also called insulin-dependent diabetes mellitus (IDDM).

Actually, all of us are insulin dependent; it’s just that some of us stop producing our own. Without insulin, muscle and fat begin to be burned for fuel (evidence of this — ketones — shows up in the urine). The person feels hungry all the time, but loses weight in spite of increased eating. Without replacement insulin, the person would eventually starve to death. Meanwhile, the concentration of sugar in the blood begins to increase. When the level reaches 180 mg/dL, the sugar begins to spill over into the urine. This causes the person to make more urine and then to get thirstier, creating an accelerating cycle.

The classic symptoms of type 1 diabetes, then, are increased urination (polyuria), increased thirst (polydipsia), increased eating (polyphagia) and weight loss. Anyone with the classic symptoms should have a blood sugar test as well as a urine test. Occasionally people also report fatigue, blurred vision, vomiting, abdominal pain, or frequent skin infections. If the disease remains undiagnosed, symptoms progress to include labored breathing, coma, and death.

People who get type 1 diabetes were born with a genetic predisposition to it. Not everyone born with this predisposition gets diabetes, however. In fact, if an identical twin has diabetes, the other twin gets it only about half the time. Along the way, some of the predisposed individuals are exposed to something in the environment that triggers the diabetes. This is usually a viral infection. The virus misleads the body’s immune system into making antibodies against its own pancreas cells that make insulin. (This is why type 1 diabetes is now also called immune-mediated diabetes).

The insulin-producing cells of the pancreas are gradually destroyed over time. When 90% of them have been destroyed, the person suddenly begins to develop symptoms. Thus, insulin-dependent diabetes generally brews for years, but appears abruptly. It rarely goes undiagnosed for more than a few weeks.

Immune-mediated or type 1 diabetes most often strikes young people, especially between the ages of 5 and 7 (when viruses run through the schools), or at the time of puberty (when so many hormones change). For this reason, it used to be called juvenile-onset diabetes. This term has now been eliminated, since we now know that it can appear at any age. About 0.1-0.2% of the general public (or 1-2 out of 1000) has type 1 diabetes. About 500,000 people in the United States now have type 1 diabetes. About 30,000 people develop it each year, and their lives will never be the same.

Type 2 diabetes is caused, not by the absence of insulin, but by insulin’s not working properly. It is much more frequent in overweight adults over the age of 45, but can occur at any age and weight. There are often no symptoms. Thus, it is often picked up on routine screening tests. The National Institutes of Health estimates that more than 7 million adults in the United States have undiagnosed type 2 diabetes.

So, Irina, given your concern about your daughter, I would recommend bringing her in. Since her hefty thirst appears to be her normal pattern rather than a recent increase, I expect you will be happy with the results.

In the unlikely event that you are not, I strongly recommend a website called children with DIABETES. Anyone who has type 1 diabetes, or anyone who has a child with type 1 diabetes, will be hooked on this site. It is loaded with excellent information and has real-time chat rooms. They call themselves “The on-line community for kids, families and adults with type 1 diabetes,” and they live up to their claim!

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Danielle Tibbs

    Dear Dr.Greene
    My mother was rushed to the hospital last nite because she was complaining of a bad headache, blurred vision and confusion. She didn’t even know who I was at one point.

    After taking her we later found out she had a concussion. They found a lot of fluid in her brain and she had to have a spinal tap done.

    My stepfather then noticed that her breath had a strong citrus smell. I’m very concerned that something deeper might be wrong. I guess my question is, what do you think would cause that? I’m worried about diabetes…she’s my best friend and I’m really afraid…..I don’t wanna lose her. I can’t. Please reply.

    Thank you so much for your time and I hope to hear back from you soon.

    Danielle Tibbs

  2. Amit Kumbhar(India)

    Dr. Greene
    Thank you so much for this valuable information. I am a Nutritionist and I am doing my nutrition practice in Pune, India. I come across a lots of different patients with variety of diagnosis and with my study I treat them with the help of nutrition.

    Your write-up is a blessing for man-kind.

    Thank you !!!

  3. Yolandi Grobler

    My sister’ s little 2 year old girl always wants something to drink at night time an then want to go pee, if she doesn’t get somthing to drink she will start to scream and cry is this normal for a 2 year old or must we be worried? ? Please answer

  4. melissa

    I recently noticed my almost 2 year old daughter drinking a lot more fluids lately. She drinks at least 7 cups full of anything. My aunt noticed it the other day and wanted me to get her looked at to see if she has diabetes. Diabetes runs in my family, my dad and brother have them.
    Thank you.

    • Use your mother’s instinct. If you think this is out of the ordinary, don’t hesitate to get your daughter checked out. It may be nothing and that would be great news. But if it is something, the sooner you find out the better.

  5. Evleena Michalis

    Dr. Greene.
    I am 17 years old. Over the past few months, I have been drinking a lot of water — 9-10 litres a day. I don’t feel thirsty or anything. I just like to drink. Even when I am simply sitting I would take a bottle in hand and keep drinking water. And most importantly I like the taste of water though it is said that water has no taste. I am worried. I mean is this even normal. I would be really glad if you could tell me something regarding this.

  6. lesego Mhlanga

    i noticed that my two year old daughter started drinking a lot of water than usual and she does not pee frequently is this normal or should I be worried?

  7. Summer

    My daughter is a severe asthmatic she lives on steriods and antibiotics on a regular basis and spends a lot of time in and out of hospital, she also has central aponea and recently sugar was found in her urine along with signs of an infection …. Can the sugar found just be a one off episode or is it something to worry about ???

  8. bianca

    Is it normal for a 1 year old to not pee a lot? She drinks a lot of water and she breastfed a lot. Even that’s the case she doesn’t pee that much.


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