A 5-year-old boy with IDDM on a single morning dose of insulin has begun to have nightly enuresis. His FBS level generally is 200-250 mg/dl, and his blood glucose level before supper generally is 75-150 mg/dl. Most likely cause of this patient's enuresis is

The development of enuresis in this child not previously enuretic is most likely related to hyperglycemia and resultant increased urine volume due' to osmotic diuresis. During the day, this may present as increased frequency of urination (polyuria). At night, in some children, it presents as bedwetting (enuresis). Most children require a split-dose (every 12 hours) of insulin to maintain good glycemic control. Emotional stress of chronic disease is an unlikely cause of enuresis. A urinary tract infection typically presents as other signs and symptoms, such as unexplained fever and abdominal complaints. If an evening dosage of insulin is too high, hypoglycemia (without obvious signs or symptoms) may occur during sleep, resulting in the release of counter regulatory hormones and an elevated blood sugar in the morning. These events, termed the Somogyi phenomenon, are unlikely to cause enuresis. Hypoglycemia may be associated with early morning lethargy, pallor, sweating, and a seizure. Enuresis is not a feature.