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August 22, 2000

Diagnosis and Symptoms

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Question from Fieldon, Illinois, USA:

I have a three year old daughter. I suspect she is having low blood sugar problems. She is irritable, always thirsty, and at times cries for 20 to 30 minutes repeating just a few words over and over. She is usually pale and won’t look directly at us. This generally has a pattern, in the middle of the night and Sunday afternoons. No amount of reassuring or even discipline makes a difference. Sometime we can get her to eat and sometimes not. She usually falls asleep after this and is sound asleep.

On Sundays, we used to grab a honey bun or other sweet donut type food for breakfast and then go to church. We lunch at about 1:30-2:00 pm. We usually eat pasta and bread sticks at a local restaurant. By 2:30 pm, you can tell when she is escalating to this state. She has almost all the “classic hypoglycemic” symptoms.

I initiated a diet change and obtained a monitor. I now give her more frequent meals. She insists on eating before bed time every night. Still, she may wake up in the middle of the night either asking to eat and drink or just screaming. After the diet change, I began monitoring her morning sugars. She has had glucose levels at 54-60 mg/dl (3.0 -3.3 mmol/l). Generally, she is at 60-70 mg/dl (3.3-3.9 mmol/l). I also monitored her once an hour after having sweet tart sucker. Her level was a 258 mg/dl (14.3 mmol/l). Is that normal considering the level of sugar in the sucker? She is finally going through most nights with just getting drinks, usually 8-12 ounces of rice milk (she is lactose Intolerant). Occasionally, she insists on something eating too. My daughter was doing considerably better for two months with morning sugars at 90 mg/dl (5.0 mmol/l). However, recently, she has not been eating well again. She has been irritable, pale, wanting to eat all the time but not eating anything either.

She is not on any medications and has had no formal testing. We have low blood sugars on my side of the family and diabetes on my husband’s side.

Is is possible to have low blood sugars and do fine for a while? Is this normal? Do you think anything else should be done? Do you recommend specific tests?

Answer:

From: DTeam Staff

I suggest that you speak to your pediatrician about confirming these high and low blood sugars. I would not rely on a home meter to diagnose borderline low blood sugar and improper technique can give a false high or low blood sugar. We have discussed the evaluation of suspected hypoglycemia previously in detail on this web site.

Briefly, you will need to obtain a blood sugar in a tube with fluoride when she is symptomatic and have this measured in a lab. If the low or high blood sugars are confirmed, further evaluation would be indicated. Sometimes a controlled fast in a doctor’s office is helpful to evaluate suspected low blood sugars. A urine obtained immediately after the low blood sugar should be tested for ketones. If the blood sugar is low, your daughter will have to undergo further evaluation to rule out any hormonal or metabolic abnormalities.

TGL