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December 29, 2020

Diagnosis and Symptoms, Hypoglycemia

Question from Missouri, USA:

Our son is adopted and his biological dad, uncle and grandpa all have type 1 diabetes. So, I have some concerns. He is 20 months old, constantly cranky, and the past few weeks he has been waking up with the slightest shaky hands, almost not noticeable, but I could tell. I checked his glucose levels for the 1st time two days ago, in the morning right when he got up. It was 60 mg/dL (3.33 mmol/l). I called his doctor and she said that “can be normal” for his age, and was not concerned The next day, he woke up a little shaky, so I wanted to test him again, I pricked him 4 times with no success, I could not get enough blood to come out. I did not get a reading, the day before I had no issues. This morning he woke up, seemed fine, I checked him, 75 mg/dL (4.2 mmol/l) reading. I fed him 10 chocolate chips, a little bowl of oatmeal (no sugar), and milk. Checked him 1.5 hours later it was 90 mg/dL (5 mmol/l). My question is, is 60 mg/dL (3.33 mmol/l) pretty low? And that was when he was not shaky. I was encouraged that his levels did not go way up after eating. Could he just have hypoglycemia? And Be dealing with low blood sugars and maybe that why he’s constantly fussy, a little jittery. Could this be a sign of diabetes at all? Pre-diabetes? Mostly I wonder because it’s in the family. Thank you for your time.


From: Dr. Stuart Brink

A blood sugar of 60 mg/dL (3.33 mmol/L) is a borderline low blood sugar value but may depend on technique if you’re having problems with checking his glucose. The other problem is that eating high fat chocolate chips slows down the absorption of the sugar in the cereal, perhaps with some fiber also contributing. So, this is not a good “test” of glucose intolerance/diabetes since it is so non-standardized. This reflects what that particular meal was, however, and the resulting blood sugar was fine. The only way to know something about these values is to get more home blood sugar values done before and 1 to 2 hours after meals. And, similarly, to know something about whether the shakiness is hypoglycemia or not, you need to check more blood sugars at the time the shakiness occurs. It is unlikely, from the information presented, that this represents diabetes since there are no reported values above 140 mg/dL (7.7 mmol/L) in the question. Could there be some genetic predisposition to type 1 diabetes with the several family members with that history? Yes. It may be worthwhile getting a week worth of pre- and post-meal values three times a day and then going for a consult with a board certified pediatric endocrinologist who works with kids this age with diabetes since there are some genetic and insulin measurements as well as antibody tests available.