April 3, 2001
Diagnosis and Symptoms, Hypoglycemia
Question from Pilot Point, Texas, USA:
My 13 year old daughter was diagnosed about a year and a half ago with hypoglycemia. She had an episode this morning, and her blood sugar was 21 mg/dl [1.2 mmol/L]. Her father, grandfather, and great grandfather, all had type 1 diabetes, and none of them were overweight, or even had so much as a sweet tooth. Her father did not get diabetes until he was in his 40s, but to listen to his mother, and knowing him for 15 years before he got diabetes, he had similar symptoms to my daughter since puberty. I asked her endocrinologist if they were related, and he told me absolutely not. Could it be that research just hasn't found a relation yet? Could it be that they just don't know yet? It seems too much of a coincidence. He wants to test for tumors, but this seems less likely than my explanation. However, I will probably have the tests done just to rule it out. I was also alarmed to see others writing about sleepwalking, and night terrors. Could this be related, if so how? My daughter sleepwalks sometimes, and had one night terror incident when she was small, but I never thought to mention it to the endocrinologist (I will now). As a footnote, I saw you telling people how unlikely it is that they have hypoglycemia. We were on the other side of that fence. For years, I went to the doctor and said; "I wake up some mornings and I find her on the floor in the bathroom, complaining she feels sick to her stomach, and she would be shaky", The doctor insisted, several times, that post-nasal-drip was causing the symptoms. Even though she had no sinus problems, and she always got better when I had her eat. When she started having episodes during the day I knew what they were because of the books I read when my husband got diabetes. Otherwise I doubt she would have been diagnosed, and I wouldn't know how to treat her. Even after I took her to an endocrinologist, it took months to get the convincing low blood sugars that he needed to diagnose her. A lot of times when my daughter gets low, my first clue is that she becomes belligerent. I read somewhere that growth hormone can cause low blood sugar. How many teens suffer from this, and then simply grow out of it? I worry that so much goes undiagnosed. it really is easier to deal with her when I know what the problem is. She now wears a medical alert necklace and others are notified, which may have saved her from great harm on a couple of occasions when she has blacked out. Can my daughter's hypoglycemia be related to her father's type 1 diabetes? If so, does she run a higher risk of getting it?
I am afraid that I don’t entirely agree with the endocrinologist. It is true that there are a number of rare metabolic disorders as well as certain kinds of tumors like insulinomas that can cause severe hypoglycemia, but, in view of the very striking family history of type 1 diabetes, I would suggest you ask to have a quick simple test for islet cell antibodies done first. I don’ t know how sure you are that the other family members with diabetes actually had type 1A, but it is by far the most likely form in a 13 year old in North America. This is a disorder of the immune system in which the destruction of the islet cells takes place over months or even years. Sometimes, and rather more often in young adults than children, the damaged islets are unable to secrete insulin appropriately in response to a glucose load and do so a number of hours later at which time the blood glucose has fallen and the result is hypoglycemia. The technical term for this is delayed first phase insulin release.