The Signs in a Newborn

An older child with diabetes can say they are thirsty or tired. A newborn cannot, so the signs have to be read from the outside — and they are easy to attribute to something else.

The things that should raise the question:

• Poor weight gain, or weight loss, despite feeding well and often.
• Nappies that are unusually heavy and need changing very frequently.
• Signs of dehydration — a dry mouth, few tears, a sunken soft spot on the head, fewer wet nappies than the drinking suggests.
• Unusual sleepiness, or being difficult to rouse for feeds.
• Fast or deep breathing.
• Vomiting, and a baby who seems generally unwell without an obvious infection.

Each of these has common, harmless explanations, which is exactly why the diagnosis is so often missed at first. In Indian studies of infants with diabetes, the diagnosis was missed at the first presentation in around two thirds of cases, and most babies had become seriously unwell — in diabetic ketoacidosis — by the time it was recognised.

The combination that should always prompt a blood sugar test is a baby who is feeding but not gaining, with heavy nappies and increasing sleepiness.