glucose in urine-possible causes?

[ariane5]

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?

Gerrard-thankyou I had a look at the carb counting link I def think I will have a try at getting to grips with it.

I have found out so much more here on mN than from the hospital I am very surprised at the attitude of the hosp I can't believe we have not got much support from them

Okay, pumps.

They're about the size of a pager and connect to patient via thin (very thin) tubing which attaches to a canula. You insert the cannula yourself! It's really easy, takes a little practice. Most come with an I section devise which means you just point and click and it's in! The pump then delivers basal (background) insulin 24/7 - imagine drip, drip, drip every few minutes! How much it delivers is determined by you/your DSN (increasingly you!) dependent on your DD's requirement. The rate is set in time blocks so you can have lots of different basal rates around the clock to suit DD's lifestyle. Time to eat? You carb count and 'Bolus'. This means you simply deliver a Bolus dose via the pump to cover meal, snack, icecream, crisps, whatever! Again, the pump will be programmed with, most likely, different insulin carb ratios for different meals.

Say your DD was out on her bike, really active ... you can set what is called a temporary basal to give less insulin so as to minimise a drop in levels. Say she's sick and running high ... sometimes you might need an increased temporary basal to keep numbers at an acceptable level. It offers you lots of flexibility and I'm probably blinding you with information which is too much, too soon!

There are three main pump companies in the UK - Medtronic, Animas and Roche. Have a look at their websites. They each have different advantages. Medtronic can be linked to a CGMS and if blood sugar goes below a certain level, then the pump will suspend insulin delivery for a couple of hours. It's called low suspend and those with sensors and a Medtronic love it. We have a Roche Accu-Chek Combo. It doesn't have the ability to connect to a CGMS but it does have a Bluetooth handset. This means that if DS is bolusing or putting a temp basal on, he does not have to take his pump out - the handset is a Godsend - you don't have to fumble under the bedclothes searching for a pump at night!

CGMS - brilliant and will give you peace of mind but they don't have 100% accuracy. They will give you lots of trend data and great trend information and will alert you to highs and lows which are on their way. Can be quite difficult to get funding for - we self-fund.

Hope the above is of some use - sorry it's an essay!!

There

Thankyou lauren-that was exactly what I needed to know, the basics explained perfectly Iam so grateful.

Pump sounds ideal. Dd is being good at the moment with jabs but only wants legs used-she doesn't complain if we do legs but if we do tummy/bottom she is starting to get upset.
Do hospitals usually fund just the pump part then and not the cgm? Is it expensive to self fund ?

We have a pump . It is great! There is a small cannula that goes in the skin , usually tummy or bottom, and we change it every 2-3 days. There is a little inserter that fires the cannula into the skin which is very easy to do. DS hated injections but loves having a pump instead.Think once it is in he doesn't feel it. Stays connected all the time apart from bath/shower or swimming when you just unclip the tubing from the cannula which stays in.
There are locks you can use on the menu to prevent buttons on the pump being pushed by inquisitive fingers.Definitely sound out your team about pumps. Am sure especially for toddlers they make life so much easier. DS would refuse second helpings or pudding because he knew it would mean another injection - now he eats what he wants & just boluses for it. Far less restrictive!
Take your time with carb counting & ask for help with it. The dietician should be helping you with it too but is fairly simple once you get used to it so you can teach yourself. Just need to either have digital scales & carbohydrate info or use carbs & cals book to estimate.
Your DSN should then help you work out what carb:insulin ratios to use - these may vary for different meals. For example often breakfast amount of insulin is relatively huge compared to other meals. The sooner you get on to carb counting food the better things will be & also you will feel more in control.
Hopefully speak to you soon on CWD. Have a go at posting to say hi you are a newbie & am sure you will get a warm welcome. Will be looking out for you!
There is usually somebody around whatever time you post and no question is too silly to ask - we have all been there!

Cross posted - perfect explanation from Lauren.

Very varying access to pumps depending on hospital attitude. Increasingly a lot of teams are starting all toddlers on pumps but not all so really good to suss out your hospital attitude now. Many parents move hospitals to get access to pumps - hence the many very positive mentions of UCLH.

Funding for CGM is even more patchy as no NICE guidelines yet for them. It is pretty expensive self funding CGM - rough ball park of around £900 for initial set up with transmitter & receiver & then sensors cost around £65 - we use Dexcom & they generally last 10-14 days.
Even with CGM you do still need to do lots of finger pricks as they aren't always accurate but as Lauren said they are good for watching trends & can be used to alert for impending highs or lows so action can be taken. You still need to do a fingerprick though to check before taking any action , eg treating a hypo.

I will ask the nurse tomorrow I think when she comes to visit.thankyou for so much info it is really helping me

My daughter has has a pump since just after her 1st birthday. We self-fund cgms using her DLA money and she has had the cgms since she was 2.5. Personally I'd focus on getting on with the diabetes learning curve and asking about pumps before thinking about cgms. There's (another!) big learning curve with cgms and it can be pretty confusing at first.

Don't worry about testing a lot, it's information that you need. We could easily test 15 times a day in the first couple of years. I think you're approach of listening to your dd and joining in with things like finger pricks will really help her. My dd is currently asleep cuddling her bear who is wearing a cannula and dd's spare pump! (She was getting fed up about being the only one who needed cannulas, so I let her put one on the bear!)

Pumps are great for toddlers. Like the poster above, we have the roche/accu-chek pump with the Bluetooth handset. It means dd can be undisturbed and we can bolus her as & when we need to without her even noticing. She sees her pump as part of her body now, I think. Even tried to get in the bath without taking it off yesterday! (Fortunately they're water-proof, but still ...)

Good luck with talking to your team. If they're not keen & you are get your GP to refer you to UCLH. They'll sort you out!

When my DS was diagnosed at 8 years old his fingers were very sore and cracking and would bleed due to excema. We got round the problem of testing his sugar levels by using his ear lobes, which have a good supply of blood and you don't use them for anything else unlike your fingers. He still uses his ears and he is 32 years old. I am trying to imagine a three years old tiny fingers, perhaps they are getting sore as you are testing so often. When I used to do the testing I often could use the same hole more than once, I admit some nurses would be surprised we used the ear lobes.

We test toes a lot too.

I've tried earlobes just once - and toes too - when DS was asleep. I think it's a great idea but I believe consistency is key and he uses his fingers during the day. Always thought it would give the fingers a good break at night.

Totally agree with Oxymoron about the order of things - CGMS a little while down the line but it's brilliant you gave looked into it and have an awareness of it.

We will be seeing the nurse today and I have lots of questions to ask her, I think I will feel much better when I've seen her. My books have arrived as well so when I get a minute I will start reading them.

Dd had a really bad night-she has a horrible cold and temp and had a hypo in the night and it was a horrendous struggle to get something sugary in her and I felt so terrified.

Does it ever get to the point where the fear goes and you feel able to go out, prepared with medicine etc in a bag ? At the moment iam too scared to be alone with dd I feel awful saying that as I love her so much but Iam scared.even if dh goes upstairs or to the kitchen I start to feel panicky will that feeling go ever?

(hugs). Yes, those feelings will settle down and diabetes will become part of life. My advice is to pack a hypo kit and go out - then you'll have done it for the first time. It will get easier - in a few weeks you'll be amazed at how much more confident you feel. You'll soon be able to feel happier about her being in a different part of the house or garden to you - promise! It's only 10 days since this elephant entered your house, that's no time. You're shocked and grieving and that's natural - and you're also learning a helluva lot in a short space of time.

Bummer during the night. It's likely your doses need tweaking and hopefully your DSN will do this today and get things levelled a bit. We always check during the night - when we go to bed and at least once thereafter depending on levels - we catch both highs and lows. It's worth checking but you get so tired!

I really hope it does get better I remember with dcs other problems (they have genetic condition and dislocate joints a lot and dd1 faints) I used to be nervous but had got to the point where we just always had a medicine bag with us and food for ds (he has anaphylactic reactions due to allergies) and we would go out and I was ok.

I feel so much worse about hypos though maybe it is just the final straw in terms of dcs being unwell.hopefully it'll just end up that we simply have a bigger medicine bag and I am not terrified of going out.
Had a bit of a breakdown this morning, dd had slept in late as her cold so bad and I just felt overwhelmed worrying she would miss breakfast got all worked up and cried and cried, then I started wondering why can't I just give her my pancreas then she would be cured and I would have it instead as I could deal with it and understand then she could be well again.
I feel like I'm going mad sometimes I hope this stage passes.dd being so good and I'm being so stupid she needs me to be strong not a emotional mess.

ariane, don't forget you are dealing with a lot right now in lots and lots o ways. I have seen your other threads and life is quite crap right now. Your anxieties may not all be about her health, underneath...but of course it is difficult.

It will get better. Diabetes is a manageable condition, it just takes training and practice. You are a great mum and you will get there.

Make sure you access all the support you can...your mum, cleaner, childcare, health professionals etc. If you need to, go to the doctor for your own sake as they will be able to help.

Please take care of yourself. Thinking of you.

You're not being stupid, it's just part of the process (including a grieving process) of adjusting to a major change. I spent 9 months seeing a parent-infant psychotherapist after dd's (very traumatic) diagnosis when she was a baby.

Yes, the fear will subside. I find the key to that is knowing what I'd do in any situation and making sure I have the kit to do it.
I keep an 'out & about' kit stocked up and never go out without meters, including spare bG meter and a ketone meter, insulin pens (in case of pump/cannula failure), dextrose tabs, glucogel and a glucagon kit as a bare minimum.

Thankyou I'm sorry I moan a lot! Things have just got gradually worse the past few months and this all just feels like too much.

I'm trying so hard to get my head round it all I just want things to all be better.

I think it IS all too much. You are dealing with waaaay way more than most people. Which is why you need to ensure you are supported. Please ask for help whenever possible. Big hugs.

Saw the nurse she was really nice and v helpful.slightly changed dd doses again to avoid night time hypos.

We do need to do a food diary as well for few days before our appt.

Good, glad appt went well.

Glad to hear that things are a little better and you are getting some support.
I am even more glad you have signed up to CWD- have a look at the FFL conferences on there. I have met some of the most amazing people- children, parents( some of whom have posted below) other type 1s, educators, therapists, through CWD and it is the most amazing silver lining on an otherwise awful cloud!
Send the CWD list a hello email when you feel able.

If Harrow aren't interested in giving you a pump soon look at moving to UCLH. I'm a doctor myself and we moved from Watford to UCLH to get better care.

Please let yourself cry and grief as you begin to adjust to diabetes in your life. You don't need to be strong all the time.

Take care

From tomorrow they are. Going to change her fom 1 unit of lantus at bedtime to half a unit of something else (levomir I think she said??)As dd is getting hypos all through the night and we struggle to get her to have anything at all and its frightening.

I am still finding doing the injections very difficult. I have to force myself to do it, I know dh would do them all but I don't want to just give up I know if I go a day without doing them then I will just give up and it'll end up dh doing them all. I'm hoping it'll just become easier the more I do. I've always hated needles dd is so so brave I am so proud of her.

Hi Ariane - sounds good! Lantus and Levemir are both basal or background insulins which act over a 24 hr period - their profiles differ slightly so hopefully Levemir will be better for your DD.

Yes to keeping doing the injections - its really hard but you really ought to make sure both of you can do everything, that way if someone is sick or away you won't be stuck.

Can I suggest that you keep a food diary as an ongoing exercise rather than just for a few days befor your appointment. As you get to grips with Diabetes you will find it necessary and really helpful.

Did you mention pumps to the nurse? I wonder what sort of response you got?

You're doing really well, you know. Have confidence in yourself and as JMF said, come and say hello on CWD when you feel up to it.

I don't hate needles but because my son was 8 he did his own injections from the beginning, I have done very few but I can still remember the first time, I was shaking afterwards and once the DCs had gone to school I sat down and cried, I can't imagine doing an injection into a 3 year old so you are doing really well. My DH has got a real fear of needles, he can't even watch someone having one on the TV. He has never done an injection or sugar level testing in 24 years or even watched my son do his.

The nurse said dd hypos at night mean they want to change her to the other basal inj and it comes in a 0.5 dose whereas lantus doesn't.

Mentioned pumps but she said for now to just carry on as we are and see the consultant in clinic in a week or two.I think I will just do a food diary anyway I would certainly feel better writing it all down and taking it to apptsn for all I know I could be giving her something wrong to eat-i assume she has a healthy diet but I could be wrong! For example tonight she was 9.2 before dinner-she had a jacket potato (small) 3 tbsp baked beans, 3 slices cucumber, 4 slices of pepper 2 strawberries, water and 50.l soya milk and 2 hours later bg was 16.9 I really feel that hosp need to see what she eats and how bg goes up/down as I havnt got a clue what I'm doing.

50 ml not l! Thatd explain a rise if it was litres!!