My daughter had a problem when she was 14 months old with low blood sugar. At one time, it was 38 mg/dl [2.1 mmol/l]. She has had some ongoing problems. We were sent to an endocrinologist, but he didn’t find anything except low blood sugar levels for 30 days. She also has some problems with healing and cyanosis around her lips at times. Could this all be related to diabetes? She hasn’t been diagnosed with it yet and she is two years, six months old. If this isn’t a problem related to diabetes, what else could it be? Our doctor is not really being too helpful.

I think it very unlikely indeed that this episode with a low blood sugar 16 months ago has any thing at all to do with diabetes, especially if routine urine specimens at doctor’s office visits did not show any glucose. It is possible though that your daughter has a very mild variant of one of the many genetically determined varieties of hypoglycemia. If there is no evidence now of any failure to thrive or any abnormality on physical examination, I think that your doctor is right not to want to proceed with what can be an elaborate investigation that might end up with a specific diagnosis, but little in the way of a practical remedy. It was interesting though that you observed cyanosis which has been quite often reported in association with irritability and feeding problems in these infants.

If, on the other hand, there are continuing significant growth problems with evidence of low blood sugars I think you should try to discuss the possibility of a referral to a metabolic unit in the nearest children’s hospital.

DOB