My 15 year old daughter has had two episodes of hypoglycemic symptoms (shaking, weakness), and her doctor ordered a three-hour GTT which showed although her blood sugar levels were normal throughout, she still had sugar in her urine, even when her blood sugar was at its lowest. She has not started to menstruate yet, and, because these episodes happened four weeks apart, I’m wondering if this could be the cause. Presently, our physician is looking for a pediatric endocrinologist in our area, to refer her to. Diabetes runs in her mother’s side of the family.

It is hard to give you any specific advice without actually conferring with you and examining your child. I do support the thought of referring to a pediatric endocrinologist.

The symptoms you describe certainly are consistent with hypoglycemia, but they are not specific. In other words, other conditions, many related to adrenalin can mimic these symptoms. If your daughter has had a history of abdominal or specifically stomach surgery, such symptoms can relate to the “dumping syndrome.” Also, the glucose tolerance test has specific requirements, that far too often are not performed by many clinics. The patient should have consumed at least 60% of her calories as carbohydrates for the three days before the test, she should have been fasting at the time of the OGTT, a specific amount of glucose (1.75 grams for every kilogram of her weight, to a maximum of 75 grams) should have been administered, and insulin levels should have been measured concurrently with the glucose. Without this information/instructions, the results should be interpreted with caution.

I am not aware of a specific link relating these spells to monthly periods, but it does seem an area worth pursuing and marking on the calendar.

In broad, non-specific terms, low blood glucose can be minimized by consuming frequent, small meals, and increasing the intake of complex carbohydrates/starches and avoiding “simple” sugars that are found in sodas, breakfast cereals, juice, and even fruit. During a spell, simple sugars would be appropriate to abort the spell.

DS