From Indiana, USA:
I need help in diagnosis. A week ago, my daughter would not wake up. This lasted about 5 hours past her normal time to sleep. She had a rectal body temp of 95. She was put in the hospital and it was discovered she had a blood sugar of 57. They said she wasn't diabetic. The following morning after an all night glucose IV she had a blood sugar of 270, sugar in her urine, and a body temperature of 99.8. Then they thought she had a possibility of being diabetic. After that her blood sugar never rose above 83. They gave her another glucose bag as she slept and the following morning her blood sugar was 74. Then they had her drink a soda pop and tested an hour later and she had a blood sugar of 78. (The doctors were shocked). We went home and have been testing her blood sugar before every meal and before bed and anytime we think something is different. The blood sugars have ranged from 69 to 107 with no morning sugar being higher than 80. She also had a Hemoglobin A1c of 7.8.
She is 4 years 6 months old, and weighs 36 pounds. She has not lost any weight recently and is a picky eater with most of the time not eating enough to keep a bird alive. She has always been very active. No unusual drinking or urinating. She averages 3 urinations a day. I have been keeping track because when she was 11 months old the same thing happened with the exception of no high blood sugar. The doctors thought about diabetes but absolutely ruled it out over 3 years ago. We are waiting for the antibodies test now but all doctors are puzzled. Her ketones have been negative. There is no known history, but I have a cousin who had several spells of this between the age of 4 to 6 years with one lasting 24 hours. My aunt doesn't know what test were run but there was never a diagnosis and my cousin is now 56 years old.
It most certainly sounds as though your little daughter had a severe episode of hypoglycemia. This might be because of what is called a delay in first phase insulin release. In other words there is a delay in the release of insulin into the blood stream after eating, which means that the insulin surge occurs after glucose levels have fallen back to normal. This is not an uncommon way for diabetes to present in young adults; but very uncommon in a four year old. In any case the antibody test should tell you if she has autoimmune diabetes or not.
If the antibody test is negative, I would suggest talking to the doctors about screening for inborn errors of metabolism especially of carbohydrate, organic acid or fatty acid metabolism.
Since your daughter's growth pattern appears to have been normal, her medical team may feel that for the time being this problem can be contained by dietary means and close monitoring of blood sugars. In this case you should get the help of an experienced children's dietitian.
Original posting 14 May 1998
Posted to Hypoglycemia
Last Updated: Tuesday April 06, 2010 15:08:58
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