February 27, 2002
Hypoglycemia
Question from Forreston, Illinois, USA:
My nine year old daughter has shown some signs of hypoglycemia since the age of four, possibly sooner, and it has taken us quite some time to finally get a doctor to hear us. She has gone from one to two episodes a year to many episodes in the past six months. During these past six months, she has many bouts of vomiting and horrible migraines which also cause vomiting. Because she is unable to fast for any amount of time, my daughter was unable to complete the five hour GTT. She made it about 40 minutes then vomited everything back up again.
Her endocrinologist has now had us place her on a no sugar diet and had us watch her blood sugar levels for a month. During this time, her sugars ranged anywhere from 68-90 mg/dl [3.8 5mmol/L]. We can find no rhyme or reason for her episodes, and she recently had another episode, during which we checked her blood sugar which was 169 mg/dl [9.4 mmol/L], and 117 mg/dl [6.5 mmol/L] an hour later. (This on a no sugar diet.) I’m baffled by this, I had assumed that we would find a low blood sugar during an episode not a higher one. She is very good at following her diet, and in fact a few times has had to remind me to check certain food items.
The majority of her spells involve vomiting, and the headaches will just appear fast and hard, generally with no warning. Just last week, she woke up at 2:30 am with really nasty stomach pains, and her seven year old brother had to come get us because she hurt so much. Eventually, the pain subsided, and she woke up fine that morning, but she was very aware of what had happened during the night. Are these common signs of hypoglycemia, or should I be looking into something else?
Answer:
You relay a frustrating, perhaps complex problem that cannot be completely covered in this type of forum. Her symptoms are consistent with, but not necessarily diagnostic for hypoglycemia. Many clinicians are not too suspicious of worrisome “low blood sugar” as the cause of symptoms unless/until the glucose is less than 40 mg/dl [2.2 mmol/L] (some say less than 45 mg/dl [2.5 mmol/L]). Indeed, a blood glucose down to 60 mg/dl [3.3 mmol/L] may be normal. Your duaghter’s symptoms of “migraines” may be unrelated. Is she treated/followed for this?
I would suggest that you ask for some dedicated consultation time with your daughter’s endocrinologist to discuss this diagnosis of hypoglycemia at some length so that you feel comfortable with his/her thoughts about following and treating. Sometimes, a formal, supervised-in-the-hospital fast over 24 hours is necessary to get to the root of hypoglycemia. A glucose tolerance test may be able to test for only a specific type of hypoglycemia, sometimes referred to as reactive hypoglycemia.
Without knowing more details of your daughter’s past health, operations, medical history, use of medications, etc, one cannot give more specific advice.
DS