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glucose in urine-possible causes?

(158 Posts)
ariane5 Mon 31-Dec-12 13:51:55

Dd (3) has been unwell lately and urine samples have shown glucose over the past week ranging from a trace to +++

What could cause this? She has been poorly a lot recently with ear/throat infections and has been very tired and had an itchy rash.

Only one of the samples showed wbc and she was treated for a suspected uti but this morning her sample was showing trace of glucose again.her diet is not high in sugar.

What could cause this?

paddyclamp Tue 15-Jan-13 21:21:39

Arian i am absolutely DISGUSTED be the lack of support you are getting. You are not stupid, the people who are stupid are the idiots at your hospital who are giving you bad advice!

I've had type 1 for nearly 30 years...when i have a hypo i have lucozade (find it difficult to chew as it makes my mouth go numb) and then i follow it up with a piece of toast or some other startchy carb or otherwise there's a very real chance i will come crashing down again!

I'm also mega suprized at them stopping the basal insulin. Have you got a designated diabetes nurse? Sorry if you've already said this, i'm just so shocked that they're putting you through this.

As i say i'm nearly 30 years into this and i was say that even i get more support with my condition that you are getting and you're barely 5 minutes into it.

Phone the hospital in the morning and demand some answers...or failing that phone your GP and ask for a different hospital!

kpandthesunshineband2 Tue 15-Jan-13 18:28:21

Awful,awful! Seriously I would run as fast as you can to another hospital with an up to date team who will also not make you feel stupid! I am horrified!

When we were on MDI we used to treat hypos with 10-15 g of dextrose & then give a digestive biscuit afterwards. Since being on the pump we were told to stop the biscuit & I think the advice was maybe also starting to change as well when on MDI.
But that is so bad you have been made to feel stupid. The main thing I guess is to work out what happens after a hypo & if just the fast acting sugar is enough to keep her up.

Your DD has been having hypos at night - it is common sense to keep checking at night!
As for carb counting not being suitable for children that is just wrong! Yes the carb ratio will vary for different children but thats what they are there to help you work out.
No idea what is going on with the basal but have a feeling a pump will be the way forward with that.
Get back onto CWD & ask about the best & quickest way to change hospital! You shouldnt be made to feel this way.

ariane5 Tue 15-Jan-13 18:02:58

Thankyou, I am just so frustrated and dreading next hypo as which way do I deal with it? We were giving the sugar then after it was up again 10-15 min later a mini wholemeal pitta. So so confused. I just feel so frustrated we have been told a million different things and this sudden no basal inj thing will dd have to restart it at some point the hosp are very vague .

gallopygallopy Tue 15-Jan-13 17:45:59

Hi Ariane, I've read this thread and am quite appalled at the amount of contradictory information and lack of support you have had. I am also a newcomer to diabetes, ds was diagnosed in July aged 12, so am not an expert, but had to come on and say you are not being stupid! Or if you are then so are we because the advice we were given and follow is to treat a hypo with dextrose/glucogel/ribena and follow up with biscuits 15 mins later, even at night. We carb count like mad. However having a teenager may be a different situation with carb counting.

I don't know how easy it is for you to get different care but our experience at Kingston (not that far from you I think) has been very different!

ariane5 Tue 15-Jan-13 17:29:05

Saw DSN and dietician today.Looks like we have been doing quite a bit wrong sad

Firstly when dd was in hosp we were told to treat a hypo with quick acting sugar eg juice or dextrose tablets/jelly babies then once it was up to give a snack like toast to keep it up so it didn't crash back down again. We have done this even at 3 am when dd down to 2 and really not with it at all we have given juice then woken her so she can hav carb snack to keep levels up till morning. Apparently that's wrong and was misinformation from ward staff we are only meant to give sugar if hypo no carb after. I feel so stupid.

Also told to stop night checks.I can't do it I'm too scared I will have to still do bg during night just in case.

Asked about carb counting as I had got the carbs+cals book and was reading on websites abt it apparently no we can't do it for dd it doesn't work in children her age and the advice in book that its 1 u of insulin per 10g carbs is not right sometimes its 1 u for 10/15/20g carbs but its not suitable for children.

They are still keeping her off the basal injection at night so she is only on novorapid at mealtimes.

I'm even more confused than ever.Maybe I'm just thick but my head is in a muddle sad

LaurenBacall Mon 14-Jan-13 09:43:20

Gosh, you've really been sent out with no information. No, don't change anything without advice. Like Paddy, when DS was younger he had much less insulin - on MDI some meals were 1 unit to 15g carbs but others were 1 unit to 20g carbs. you couldn't possibly figure it out without proper medical advice.

Good luck tomorrow.

ariane5 Sun 13-Jan-13 22:57:50

I am really hoping that on tuesday things get sorted out I am going there with the food diary BG diary and a huge list of questions as I can't carry on like this for much longer.

Dh was saying earlier how on paper dd diet looks quite healthy but really we have no idea if anything we are giving her is wrong. We don't have a clue.

paddyclamp Sun 13-Jan-13 22:49:19

This is where your medical team should be helping you get out....i've always had a ratio which has varied depending on a number of factors but when i was younger it was 1 unit of novorapid per 15g of carbs

I don't weigh food out now cos i've just got that used to it that i'm pretty good at estimating smile ..... but NO WAY should you have been left to do it all by guess work!

ariane5 Sun 13-Jan-13 22:37:14

Yes 1 unit with each meal regardless of what she is having in fact we have had no real advice about food except one leaflet from hosp about snacks.

I got the carbs+cals book and from what I can see dd is not having enough insulin for the amount she eats (I may be wrong) she has had a lot of hypos 2 in the night and 2 this afternoon she gets quite low v quickly we have to give her juice then she's really high again(16).

We have done a food diary and a BG diary since being in hosp-bg on waking before meals and 2 hrs after before bed and we check at 12 and 3am, at 12 bg usually quite high but it starts to plummet around 3am and sometime after that dd has hypos around 2.5 so after 3am we know we have to keep checking her.we tried waking her when it got to 5.0 to give her a snack but she still had a hypo an hour or so later.

I don't want to adjust her insulin myself based on what she eats as I would worry about overdosing her.I am really confused though as things like 1 potato waffle in the book was 12g carbs and it said 1u per 10g carbs so if dd has a dinner of 1 potato waffle, vegetables and 2 fish fingers plus a bowl of plain soya yog and strawberries (that's the sort of quantity she has) then surely her 1u will not be nearly enough to deal with the meal she's just eaten??? Or am I getting it wrong (Iam v bad at maths and similar things).

SO confused by it all

LaurenBacall Sun 13-Jan-13 20:45:54

Ariane, I second what Paddy said - don't stop the night checks. Always do them, even when DD is stable - you will catch highs and lows. Many of us consider it dangerous not to test at night.

Do you give a flat 1u of Novorapid with each meal? Have they taught you anything about carb counting? Even when DS was first diagnosed we did rough carb counting - he was also 3 and on a different regime but we had to match carbs to insulin which was awful. Have you done any BGs two hours after a meal? The number then would give you an indication as to whether or not the 1u is working but truly you'll never know unless you carb count.

The more I read the more I thnk referral to another hospital - immediately!!

Hope today was better.

OxyMoron Sun 13-Jan-13 00:59:15

Yes, weight affects insulin dose. The smaller you are the less you need in general, but lots of other factors affect it too (e.g. growth hormone activity means you need more insulin).
I would seriously consider asking to be transferred to a better team. There have been recommendations on this thread. Even though we parted from our original team, they were good at the beginning. We had a 10 day stay in hospital (not usual, but my dd was extremely sick at diagnosis), a structured education process, frequent home visits initially, and a full list of contact numbers including out of hours care. You could ring the main switchboard at your hospital and ask for the on-call paediatric endocrinology registrar, or the on-call paediatric registrar. I'd also consider talking to PALS about the lack of support.

Hope you have a reasonable night.

ariane5 Sun 13-Jan-13 00:45:33

From what I know dds other medical problem (ehlers danlos syndrome) shouldn't affect blood sugar/diabetes in any way at all.It is a disorder of the connective tissue so she has problems like pain, fatigue, dislocations, constipation and a hernia. It has never had an effect on any medication before and I made sure all tje doctors we saw in hosp knew she had eds and they didn't mention a link.

She is 3 and weighs 13.6kg so not sure if weight/age affects insulin dose?

Iam just confused and worried and not having had proper advice has made me more anxious-I knew that day in hosp when dd had a hypo and the nurse wanted to give dd insulin then lunch that things would be difficult.

paddyclamp Sun 13-Jan-13 00:15:11

Def don't stop the night checks...i test my blood about 10 times a day so you can never do too much testing! What the heck are they doing telling a newly diagnosed parent to test less?!?

I know it's different for me because i'm an adult but your DD seems to be on very little insulin so she must be in a honeymoon, or maybe it's more complicated because of the other medical problems she has? ..... I take 14 units of basal, and 1 unit of novorapid for 10g of carbohydrate, so eg at breakfast i have 7 units.

Things is, all the books and information from us guys isn't the same as proper medical advice for someone who knows your are being treated appallingly IMO...get on the blower in the morning and demand a review...don't worry too much tonight as nothing drastic will happen now that she's had some insulin but you shouldn't be going through this alone!!

ariane5 Sat 12-Jan-13 23:48:42

We have a number for the childrens ward if we need to speak to a doctor.
I have been surprised how dd bg has been quite low today I assumed with no basal inj it would creep up but it has been low (well low for dd around 8-12 most of day with a couple of drops to 4 or5). Usually we have highs in the afternoon of anything up to 18 (which makes her suddenly fall asleep).

I am finding it all confusing but everytime I get a spare min (not often!) I've tried to read some bits from the books I've got (that were recommended on here).

OxyMoron Sat 12-Jan-13 23:31:22

Honeymooning is the only reason I can think of for stopping basal insulin. The honeymoon is the period after diagnosis, once insulin has been started , where the pancreas reactivates a bit and uses its remaining beta cells. It means the child needs much less insulin than they do later one when more beta cells have died off. I have never dealt with it as my dd had no honeymoon period.
I would keep a close eye on her bG and ketone levels, and don't stop the night checks if she's hypoing at night.
Do you have out of hours numbers to contact your team when you need to ask questions?

ariane5 Sat 12-Jan-13 23:23:41

Yes novorapid 1 unit at mealtimes.last night hypo she was 3.8 previous night 2.7 and 2.8 night before that. They had told us to stop 3am check but I couldn't just in case iam glad I ignored them.

I feel exhausted by all this its ridiculous I have ordered books to read but I am not a doctor a lot of it is confusing.
No mention of carb counting yet we are just giving her her 'normal' meals trying (and hoping) that we are givinng her the right things.

paddyclamp Sat 12-Jan-13 23:06:45

Is she then having novorapid with meals? Have they gone through carb counting?

Honestly this is insane!! .... I know how little friends and colleagues know about type 1 and how i have to explain it to them, so how the heck they expect a parent to look after their child with so little information i'll never know!!!! .... How low has she been? I think i would turn up at the hosp and demand some answers!

ariane5 Sat 12-Jan-13 22:51:00

Initially in hosp 3 units at night they reduced it to 2 after couple of days and then down to 1 unit as she was still having a lot of hypos.last night was 14t night with no basal and she still had hypo during night and bg was quite low today.

Iam frustrated at the lack of info and support from hosp DSN was nice and helpful when we met her but the whole period over xmas and new year and the week in hosp nobody told us much and we got a lot of conflicting advice.

paddyclamp Sat 12-Jan-13 22:26:53

No offence OP but your DD's medical team don't seem to know whether they're coming or going!!! I can't believe how little you seem to be receiving in the way of information and support...when i was diagnosed i was in hosp for 2 weeks!! i know that's no longer the case but it gives you an idea of the scale of information we had to get used to!

The hypos will almost certainly be due to the honeymoon period where her pancreas starts producing some of its own insulin before it finally gives up the ghost - this can last for about 6 months

How much basal insulin was she put on before they asked you to stop it?

ariane5 Sat 12-Jan-13 21:07:47

Ok, Iam worried now WHY would they stop dd basal injection ? Should I just start it again? They said to not do it until they see her on tues in clinic?

I joined cwd but can't get on computer only on my phone so can't put anything on there and ds2 still up so I'm so busy.
I'm so worried dd had a hypo last night again I don't understand I thought without the basal she would be higher today but actually she has had lower bg.the nurse kept mentioning honeymooning is this something to do with that?

What do I do re basal inj ? I am scared something will be wrong now I don't understand what on earth the hospital are doing. Dh spoke to them on phone not me maybe I should try to phone the ward?

paddyclamp Sat 12-Jan-13 19:59:14

I've always been told NEVER to stop my Lantus (basal) even if i'm ill and not eating confused

kpandthesunshineband2 Sat 12-Jan-13 00:18:49

Sounds odd not having any basal. Make sure you check for ketones if glucose levels start to rise over weekend. Thought you would still need some basal!

If it is impossible to get low enough dose of lantus/levemir without causing hypos then this is where a pump would be much better as can give smaller doses & have different basal levels at different times of day.

ariane5 Fri 11-Jan-13 20:52:16

Jmf294-I cannot seem to pm whilst on my phone but once I have a pm I can reply, would really like to meet up if possible at some point if you still don't mind just pm and I can reply to you.

ariane5 Fri 11-Jan-13 20:47:07

Lantus was being given at night around 10pm I forgot to add

ariane5 Fri 11-Jan-13 20:44:47

I think I know what I've been doing wrong ! On phone at moment but when I can get on computer I will have a try to post on cwd.

We were meant to collect the levemir today but nurse phoned and said nothing till tues and they will see dd then, I was worried she would start getting v high but hopefully she won't she has been really really low from about 3am every morning.
The nurse also changed dd to a glucomen monitor that does ketones as well.

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