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June 4, 2008

Behavior, Diagnosis and Symptoms

Question from Tacoma, Washington, USA:

My now six and a half-year-old was diagnosed with hypoglycemic episodes at the age of four. She underwent may tests (ACTH, kidney checks, insulin levels, fasting glucose, etc.) and the conclusion was simply a fast metabolism and frequent snacks. I have a glucometer to check her occasionally, too. For about a year or so, her behavior has been very erratic and unusual. She is incredibly moody, refuses to listen to simple requests, refuses to do certain activities at home and at school and is falling very far behind in math. She is not aggressive, but has had some behaviors that are incredibly mean to other children. I know six-year-old girls have a bad stage they go through but it's almost as though she's another person. I'm worried about diabetes looming in her future because she is following the exact same path as my half-sister did before her diagnosis at the age of seven. She is now almost 16 and a very hard to treat type 1 diabetic. I asked the endocrinologist about a future diagnosis of diabetes when she was four and he said it never happens with hypoglycemia cases like this. My question is: do you see extreme behavior changes and hypoglycemia episodes a couple years before a diabetes diagnosis? I'm constantly checking her blood sugar and watching for signs but, aside from the above, there is nothing physically wrong with her.


There are some cases of type 1 diabetes that start with mild hypoglycemia for several months and rarely for several years before the pancreas “dies” and the insulin production ceases. The more prolonged the documented hypoglycemia, however, the less likely in my experience so this may be what the endocrinologist was talking about. If you are unsure, then you should consider a formal consultation. Bringing a profile of pre- and post-meal blood sugar readings for a solid week would be very useful for review. Also, consultation with a good child psychiatrist or psychologist would also be helpful since such problems that are emotional can show up very similarly. One might consider some antibody testing to see if there is any evidence of inflammation in the pancreas as a forerunner to diabetes, but this is often more a research tool than clinically helpful.