August 25, 2008
Diagnosis and Symptoms
Question from Denham Springs, Louisiana, USA:
My 10-year-old daughter is 4 feet, 4 inches and weighs 53 pounds. For the last two years, she has been having episodes of getting clammy, pale, and dizzy, with a headache, stomach ache and blacking out. If you can give her sugar, she comes back around within 15 minutes. She does not have to be doing anything to trigger these episodes. We have been through six doctors in the last three years. Our new doctor re-did a four hour OGTT with insulin and her results have changed. Her A1c in the last six months has stayed at 5.5. Her OGTT results follow: (insulin first) fasting – 16.5; one hour – 29.1; two hours – 36.9; three hours – 93.1; and four hours – 123.5. Her glucose was: fasting – 92 mg/dl [5.1 mmol/L]; one hour – 85 mg/dl [4.7 mmol/L]; two hours – 108 mg/dl [6.0 mmol/L]; three hours – 135 mg/dl [7.5 mmol/L]; and four hours – 88 mg/dl [4.9 mmol/L]. Her doctor has mentioned MODY as a possibility. Could this be MODY or is this the start of type 1? What test should I request to see what this is? What treatment should we be considering?
Answer:
It sounds like classical hypoglycemia, not diabetes. The OGTT results suggest excess insulin so, making sure she is not overweight is critically important. It would be very important to document actual blood glucose during symptoms. If not below 60 mg/dl [3.3 mmol/L], then other autonomic dysfunction is more likely. Growth hormone and cortisol levels during hypoglycemic episodes should also be checked to be sure there is no insufficiency. Occasionally, celiac presents like this as well as thyroid dysfunction. More than 95 percent of kids with hypoglycemia like this can have symptoms prevented by (1) avoiding simple sugar: candy, soda, juice, fruit, etc. and (2) always eating something with protein and fat every three hours (cheese, peanut butter, meats, eggs, etc.).
SB
