Recently, my five year old son had a six-hour fasting glucose test, and his pediatrician said that he had hypoglycemia but would not tell me if this meant he had diabetes or not, and she was not clear about his actual test results. He also had an A1c done which she said was within normal range. She instructed me to test his level a few times a day and give him a balanced diet of protein and carbohydrates in small meals several times a day.

The diet has helped his levels some but not all his levels are low. He has irregular readings no matter what the time of day which can be as low as 38 mg/dl [2.1 mmol/L] and as high as 360 mg/dl [20 mmol/L]. Does this mean my son has diabetes? Does he need to see a specialist? What should I do?

From your letter, your son does not have diabetes. Diabetes is associated with elevated blood glucose levels, while hypoglycemia is low glucose levels. There are many causes of hypoglycemia, but most are not worrisome and are treated in a manner similar to what you have outlined: frequent small meals, limiting “simple” sugars, eating more complex carbohydrates and starches.

Most younger children with hypoglycemia have what is often called ketotic hypoglycemia. Most children with this are thin, and as they get older with increased muscle mass and fat mass, the hypoglycemia propensity goes away.

Frankly, I am skeptical about glucose readings at home to 360 mg/dl [20 mmol/L]. I would ask that you ask for a referral to Certified Diabetes Educator — not because your son has diabetes now, but such educators are skilled in the most proper methods and techniques to help you accurately and appropriately check the blood glucose with the various meters. They can also guide you as to meal planning for the child with ketotic hypoglycemia. You should feel comfortable in asking your child’s doctor your questions. Ask if she checked for ketones during the hypoglycemia.

DS