Question from Omaha, Nebraska, USA:

My eight year old nephew has had many problems with hypoglycemia since he was 18 months old. Normally his blood sugar runs between 59 and 80 mg/dl [3.3 and 4.4 mmol/L]. This young man has had some history of seizures, which have been diagnosed as secondary to severe hypoglycemia. My sister has been able to maintain her son’s blood sugar with complex carbohydrates, extremely limited refined sugars, and snacks two to three times per day.

For the past three months, my nephew has been exhibiting some changes (difficulty focusing on written words, increased thirst and drinking, frequent urination, and, most recently, falling asleep in school one to three times per day). The teacher have been giving him snacks after waking him, and he falls asleep again. His blood sugar, on meter testing, has been running 98-130 mg/dl [5.4 -7.2 mmol/L], and this is highly unusual for this young man.

My nephew has been under the same physician’s care for several years now. This past week he had a fasting glucose and fructosamine level drawn. The results were normal. Other than a referral to an endocrinologist, the physician was unable to offer other thoughts. No new diagnosis was identified.

I would appreciate thoughts and/or suggested next steps to offer to my sister and nephew. They live in another state.