Monday, December 31, 2007

Polydipsia and polyuria

No point in saying 'drink a lot' or 'pee a lot' when docs can obfuscate the issue with a fancy name for it. Either way, people know these symptoms to be possible signs of diabetes, and they tend to worry when do just that, peeing and drinking more than usual.

My friend J tends to worry no matter what, and anything out of the ordinary in her health or her family's health sends her into a tailspin. So when her son noted that he seemed to be going to the bathroom frequently, she did what she always does in circumstances such as that, she called me.

In H's case, the two important things to consider were: 1) Which came first, the polydipping or the polyurring?, and 2) How was he otherwise?. This young man was definitely a polydipper, drinking the recommended 8 glasses of water per day (which, incidentally, has been recently exposed as one of the top medical myths, so you're off the water-slugging hook!). If you dip a lot, you pee a lot. In addition, he was inclined to hit the head whenever the notion hit his head. If you give in to your bladder every time it twitches a bit, you end up with a lazy-ass little bladder which is unwilling to relax to accommodate even a little shot of urine arriving from the kidneys. This is a common problem among older women who have trained themselves to use the restroom whenever there's an opportunity.

Except for his frequent urination, H otherwise felt well. His energy and weight were good. He slept soundly through the night with no trips to the bathroom. Consider, on the other hand, the polyurring diabetic. They don't just pee a lot of regular old urine, night and day, they're peeing out excess sugar from their blood. The sugar makes the urine concentrated, so the kidneys send out a lot of water with it. As a result, uncontrolled diabetics are basically starving--and dehydrating--in the midst of plenty, their nutritional load pouring into the sewage system instead of into their cells. They begin to lose weight, and lots of it. I had a patient once who was basically a blob, both in personality and body shape. To his delight, his excess flab began to disappear effortlessly; this was too good, slimming down with neither diet nor exercise! His blood sugar, when he finally came in due to exhaustion, was 426. (His personality changed not a whit.)

Please note, however, that this load of poly-trouble characterizes Type 1 diabetes, the kind that begins abruptly and more often in children than adults. Type 2 diabetes, which generally develops in adults as a result of part genetics and part lifestyle, has a more gradual onset and is not associated with the sky high sugars and resultant sugar-laden urine seen in Type 1.

I was able to reassure J and H that diabetes was not a consideration in his situation.


Ruth said...

My daughter complained of polyuria during a hot July when she was drinking a lot. I booked her for a blood test and her sugars were sky high...type 1 diabetes at age 17. I still feel the gut wrench of shock, because I minimized her symptoms. Her identical twin sister is part of a study at the Hospital for Sick Children in Toronto because she is at risk for developing this disease too. Good detective work is essential.

Mauigirl said...

So now I have to feel guilty for peeing too often - apparently I'm spoiling my already walnut-sized bladder and it's going to get even smaller? Great! ;-)

If I wait TOO long I find it hard to make it there! LOL!

Thanks for the excellent explanation of when a person should worry about diabetes.

Femail doc said...

Good point Ruth, we always have to take symptoms seriously even if an easy explanation like hot summer weather exists. I've learned that lesson more than once. I had a gut wrench myself in an opposite sort of situation when I took my son's symptoms too seriously, and he ended up having some unpleasant tests unnecessarily. There's a downside to Dr. Mom.

Mg: Go easy on yourself. If you don't spoil your bladder, who will?