My 11 year old son, diagnosed with ketotic hypoglycemia when he was seven years old, has had blood sugars as low as 28 mg/dl [1.6 mmol/L] and as high as 250 mg/dl [13.9 mmol/L] but has not been diagnosed with diabetes. Recently, his blood sugar was 62 mg/dl [3.4 mmol/L] before dinner, and he was very symptomatic (shaky, pale, sweaty and very irritable). Then before his bedtime snack he was 176 mg/dl [9.8 mmol/L] and didn’t want his snack, but he still complained about not feeling quite right. So I re-did his blood sugars about an hour later, and it was 237 mg/dl [13.2 mmol/L] about five hours after dinner. Is this normal?

Because the word hypoglycemia is so often associated with diabetes, even though there is no association between ketotic hypoglycemia and this disorder, I am assuming that your main concern is whether blood sugar levels as high as 250 mg/dl [13.9 mmol/L] might indeed be diagnostic of diabetes. The simplest way to get an answer might be to have at least two fasting blood sugar levels run in a clinical laboratory.

In theory, a fasting level greater than 126 mg/dl [7 mmol/L] or alternatively a random one over 200 mg/dl [11.1 mmol/L] could be diagnostic, but in children, the stress surrounding this test, knowing parental anxiety, may easily raise blood sugars beyond the normal range. For this reason, I would ask your son’s doctor to do a full antibody test (GAD 65 anti-insulin, and ICA 512, not just a screening one. You might be asked to bear the cost of this, but even so, I think it would be the most expeditious way to resolve your concerns. If the test is negative, it would then be very unlikely indeed that your son has type 1A (autoimmune) diabetes including those very rare instances where this presents with low blood sugars due to delayed insulin release. If the test is negative, you may still need to discuss with the doctor whether any further evaluation of low blood sugars is justified and whether the high blood sugars are just a normal counterregulatory hormonal response to hypoglycemia.

DOB