My daughter, age 34 months, has been vomiting on and off over the past month. Last week we took her in to see the doctor, who ran blood tests and all was normal except her glucose, it was 54. We repeated it the following Wednesday and it was 150. So far she has only vomited one more time, but she is otherwise a healthy, energetic child who will choose candy over any other thing offered to her, likes she craves the stuff. We have an appointment to see a pediatric G.I. specialist soon, for her vomiting, but I wonder if her vomiting and low blood sugar could be related. There is a strong family history of diabetes on both sides. My daughter is only 27 lbs and 27 inches tall, small for her age, but following in the same pattern since birth. Any helpful information, or advice on how I should proceed with her would be appreciated.

I would follow the advice of your child’s doctor and also go ahead with the referral for her vomiting. The signs of diabetes would be increased thirst and increased urination. There may also be poor growth noted. Vomiting without high blood sugar and ketones would not make me think of diabetes. The blood sugar of 54 that you report is actually at the lower end of the normal range, and consistent with a child who has been vomiting.

The blood sugar of 150, although higher than the normal range, may or may not be of significance. I am assuming that these are laboratory blood sugars rather than meter blood sugars. (If they are meter sugars, they need to be redone by lab as home meters are not able to distinguish between normal and low, or high versus high end of normal.)

If you have continued concerns about diabetes, ask your doctor to give you urine glucose strips that you could check at home, and repeat the blood glucose level one hour after a high carbohydrate meal. There is also something called “stress hyperglycemia” which is not diabetes but a temporary rise in the blood sugar due to an illness, infection or other medical stress or from certain medications. The way to distinguish stress hyperglycemia from diabetes, is to follow-up on the blood sugars to see what happens as the stress resolves.

LM