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February 28, 2001

Diagnosis and Symptoms

Question from Raleigh, North Carolina, USA:

My 11 year old son had pyloric stenosis surgery when he was two months old. Every since he was young, he has always vomited during the night on an average of once per month, sometimes more and sometimes less. His legs shake, and he is not very coherent during these times, and, until the last year, he never was able to make it to the bathroom on time. We have tried to target a food allergy, but we have not found one. After reading some of the questions and answers on your page, I wondered if he could be experiencing a drop in his blood sugar during the night. He seems fine when he wakes up in the morning, though sometimes he is tired. His vomiting does not appear connected to any diarrhea. Should I have him checked for diabetes?

Answer:

It would be very unusual for autoimmune diabetes to present with nocturnal hypoglycemia and especially as infrequently as once a month.. What does happen occasionally is that partially damaged islet tissue will show a delayed response to a glucose load so that the insulin is secreted inappropriately at a much later time when blood glucose levels have subsided and hypoglycemia results. In your son’s case however this symptom seems to have persisted from infancy and in that time type 1A diabetes would certainly have become insulin dependent. In short, I do not think he needs to be investigated for diabetes unless you are particularly anxious, in which case you should ask his doctor about an antibody test. This is not to say however that the symptoms you describe are not due to hypoglycemia, indeed the shaking, the incoherence and the vomiting are quite typical.

I don’t know how far this has already be pursued and I can understand the practical difficulties of measuring blood sugars during the night to pick up an event that may only occur once a month.When the GlucoWatch becomes available later this year it would be easy. For that reason I just wonder if it might not be worth talking to his doctor about the possibility that this is a late complication of a pyloromyotomy; but Long-term effects of pyloromyotomy on pyloric motility and gastric emptying in humans (Am J Gastroenterol, 2000 Jan;95(1):92-100; Sun WM, Doran SM, Jones KL, Davidson G, Dent J, Horowitz M) was the only abstract I could find and whilst it was concerned with changes in pyloric motility some years after the operation there was no report of vomiting.

DOB