October 19, 2003
Diagnosis and Symptoms
Question from Shelby, Ohio, USA:
When my now two and a half year old daughter was 16 months old, she had a seizure in the pediatrician’s office. I suspected an ear infection, and her temperature was 102.7oF at the time of the seizure. She jerked twice, went unconscious, and turned blue. Her chest was not rising, and there was no palpable pulse. The pediatrician had to perform three rounds of CPR before spontaneous breathing/heart rhythm returned. To make a long story short, she had a brief visit to the ER where she was stabilized, and she stayed overnight stay at the children’s hospital for observation. After several blood/urine tests and the like, the diagnosis was febrile seizure.
The problem I have with that, is that after her seizure, her blood glucose was below 30 mg/dl [1.7 mmol/L]. (I don’t know the exact number.) We have a family history of diabetes, and she now displays symptoms of hypoglycemia, yet her pediatrician assures me that she does not have any problems. Testing for diabetes has gone no further than a simple finger-poke in the office which was in the 90s mg/dl [5 mmol/L]. My mom and I have randomly tested her at different times (about three times total). The highest was 336 mg/dl [18.7 mmol/L], and the lowest (other than her seizure) was 79 mg/dl [4.4 mmol/L].
Do you feel my daughter’s seizure was caused by the low blood sugar? Can someone who does not have diabetes have blood glucose readings out of the “normal” range?
Answer:
This is a very interesting question. I will give you my opinion.
Firstly, yes, someone who does not have diabetes can have periodic instances of fluctuating glucose levels, depending upon meal intake, acute health issues, activities and others. Monitoring at home needs to be done carefully assuring clean and dry fingers on a reliable and calibrated glucose meter. However, home monitoring is only a screening test. If irregular, more definitive testing is typically required.
Typically after a seizure (febrile or otherwise), the glucose level is higher, not low, so I am bothered by the glucose of 30 mg/dl [1.7 mmol/L] after the convulsion. I am also a little surprised that vigorous CPR was required to revive her, and yet she was able to go home the next day. I wonder if there is more to the story than is appreciated. But yes, a drop in glucose can trigger a seizure.
Other things, some hormonally derived and not directly related to diabetes, can predispose to low glucose. In a sick, febrile toddler, the first thing that would come to my mind about the glucose of 30 mg/dl [1.7 mmol/L] is that perhaps your child missed some scheduled meals and “used up” the stored glucose levels. This is sometimes referred to as ketotic hypoglycemia. An easy way to assess for this would have been if a blood or urine test at/near the time of the low glucose showed the presence of ketones.
DS
