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March 3, 2003

Diagnosis and Symptoms

Question from Toronto, Ontario Canada:

My six year old daughter is generally a well and happy child, but over the past few months, we have noticed increased "moodiness", often for no apparent reason. We wrote it off to being "tired", as it occurred usually upon waking in the morning, at the end of the school day, and before bedtime. My husband has diabetes, and a few months ago, we tested her sugar, just to see how hers was. (I suspect she might have been acting "out of sorts" at the time, but I can't recall.) At the time, her sugar was about 3.4 mmol/L [61 mg/dl], and we didn't think too much more of it. About six weeks ago, she went through a month or so of vague "stomach pains". We took her to our family doctor, who gave her a brief check-up, but then decided she was just one of those kids whose stress, etc. manifest itself that way. Last night, she came home from a friend's house, and at pick-up time, the mom said she thought our daughter might be coming down with something, as she was flushed, and more tired than usual.She was in a horrible mood when she got home, asking for a snack. She had some sherbet, and some cheese and crackers. Then she gave herself a bad paper cut, and got really upset. In an attempt to distract her, I suggested we use her bleeding finger to test her blood sugar, so the blood wouldn't be "wasted", and 1.5 hours after a reasonable dinner (and 15 minutes after those two snacks), her sugar level was 2.8 mmol/L [50 mg/dl]. Based on my knowledge of levels, I thought this was quite low. So, we gave her a hard candy, and another snack, and checked it before she went to sleep, at which time it was 5.1 mmol/L [92 mg/dl] (but she must have consumed close to 100 grams of carbohydrate in snacks in that hour). I called the doctor this morning, and we have an appointment for a month from now, but the doctor didn't seem to think it was really necessary. She's seeing us more for our "peace-of-mind". She, through the nurse, also told us to stop testing our daughter's sugar, as there is nothing to be concerned about. I am, nonetheless, still concerned. she has been experiencing more night waking lately, although she has never been a great sleeper. she is eating three meals a day, plus at least three snacks, and is not under or overweight. Is there a test to track low blood sugar over time? Do you think that a pattern of "mood changes" etc might mean my daughter has hypoglycemia? Should I insist that my doctor, who I generally think is pretty good, refer us to a pediatric endocrinologist?


I am not sure that you need to see an endocrinologist at this point. I am also uncertain that I would “label” your child as having hypoglycemia at this point either but one cannot ignore the information that you have uncovered. There are many possible causes of hypoglycemia, some worrisome — but most not. What I often due with such patients is the following:

Start avoiding “simple sugars” as in frosted cereals, juice, soda, candy, etc. except if the glucose is confirmed low and then only to treat the low.
Emphasize a diet richer in complex carbohydrates (pasta, rice, potatoes) and protein with more frequent smaller meals.
Have the child have their own glucose meter so that glucose levels can be checked routinely (e.g. before each meal and at bedtime) and whenever there is a “spell.” I would do that for a few weeks and then you can bring the data to your doctor at the scheduled appointment. Talk to your daughter’s doctor to see if they can agree or modify this type of a plan.


[Editor’s comment: See Other causes of hypoglycemia at the Diabetes Monitor.