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June 11, 2013


Question from Johnstown, Pennsylvania, USA:

In October 2012, my daugther marked her two year type 1 mark. Prior to this, we had encountered low blood sugar episodes that left her noticeably shaky and confused, but that was the worst of it. Around that two year date, she had her first really troubling low episode that occured overnight. Since then, she has been experiencing them about once/month. They all happen when she is sleeping and has been running on the low side for a while. She will wake up screaming (repetitive-like), glassy-eyed, even in a kind of focal seizure (not sure if that is exact, but she twitches and has involuntary movements of her arms, gets rigid on one side at times). We have been able to get her out of these episodes by using icing and have not had to administer glucagon. These are extremely scary and I am wondering if this is a common occurrence and why she went two years and never had this happen before. Our doctor commented that low blood sugar can cause night tremors. She is only 4 and is not able to recognize her lows.


Hypoglycemia can be asymptomatic, with mild symptoms or more severe. Night time hypoglycemia often is more severe since there is significantly less chance of warnings. The younger the child, the less likely that symptoms will be recognized. Some people have a more difficult time recognizing hypoglycemia than others. More hypoglycemia that occurs in episodes closer together also makes it more difficult for the body to signal that the hypoglycemic episodes are occurring. We only understand some of these factors. The key remains minimizing or avoidance of hypoglycemic episodes while, at the same time not consciously or unconsciously, producing chronic high blood sugars. Sometimes there are also other conditions that co-exist and increase the risks of hypoglycemia episodes so be sure that checks for adrenal insufficiency, thyroid disease and celiac disease have been done.

Periodic overnight monitoring would also be helpful to determine how often such hypoglycemic events are occurring. We have many of our patients use continuous glucose monitoring for a week to get such overnight monitoring results in an easier fashion and look for trends and patterns. Most importantly, please review with your diabetes team to help problem solve and decrease the hypoglycemic events.