December 5, 2002
Diagnosis and Symptoms
Question from Summerfield, North Carolina, USA:
I am concerned because my two year old daughter has had blood sugar abnormalities for approximately a month. The first time they checked her glucose level it was 146 mg/dl [8.1 mmol/L], so I took her the next day to have blood drawn, and she has a fasting glucose of 44 mg/dl [2.4 mmol/L] with a normal A!c. I pursued my family physician due to the fact that the fasting glucose of 44 mg/dl [2.4 mmol/L] concerned me. In turn, they asked me to monitor her glucose level at home and sent me to have more blood drawn and a urinalysis. Her random insulin level was less than 2, her thyroid was normal, and her glucose at this point was normal. Since i have been doing fingersticks in the morning prior to breakfast and in the evenings after dinner, her glucose levels have remained normal.
She weighs 24 pounds, there are periods of irritability, and she is very difficult to wake up some mornings. There are also times where I will check on her in bed and she will be sweating in her sleep. She has periods of thirst as well. We have been referred to a pediatric endocrinologist, but they have not contacted us for an appointment yet, and the whole thing puzzles me greatly. Any idea as to what is causing these abnormalities?
Answer:
It is difficult to know form what you have described so briefly. It could be ketotic hypoglycemia, reactive hypoglycemia, or it could be the earliest phases of diabetes developing with normal insulin response, sometimes due to insufficient insulin and sometimes excessive insulin.
Doing lots of blood glucose readings will help you figure out how often things are happening. Sometimes just staying away from concentrated carbohydrates is all that is needed coupled with a six meal feeding program (never going more than three hours apart and always having low carb, protein, and fat with every meal and snack. This means things like cheese or peanut butter usually.
Going to see a pediatric endocrinologist would be helpful. Bringing the team lots of blood glucose readings would also help save some time. What you describe is certainly not normal but something that, as pediatric endocrinologist, we see all too frequently.
SB
