My 16 year old daughter, who has type 1 diabetes, is active in three high school sports, and last spring during track practice, she experienced an episode of hyperventilation. Around this time she also developed pneumonia, which was treated by her endocrinologist. She did not have any more episodes during the summer during which she trained with and played in several tournaments with an elite basketball team. However, this past weekend she experienced another episode at the end of an intense conditioning practice for the high school soccer team.

She has described symptoms of shortness of breath and a feeling that she was going to vomit and pass out. She did not test her blood sugar during the episode but did after practice and did not report anything unusual. I am wondering whether this could be an early indication of asthma or exercise-induced hyperventilation. She does not appear to have a cold/cough, but I have heard her cough a few times at night. Are there symptoms that we should monitor before meeting with her endocrinologist? Could her diabetes have an effect on or cause these episodes of hyperventilation?

I think I am a little uncertain as to what you mean by “hyperventilation.” Of course with/after exercise, there should be a change in the respiratory pattern with increased numbers of breath and deeper breaths. However, I gather you are describing something else. A consequence of hyperventilation can include a tingling to the mouth and digits and even muscle spasms as the alteration in body acids/bases can lead to changes in the calcium concentration available to the nerves and muscles. Exercised-induced asthma would typically lead to a feeling of shortness of breath or cough. I wouldn’t described shortness of breath as “hyperventilation.”

In general, I would not think this has any direct relationship to her diabetes. I think she does need to be seen by her doctor, but, while her endocrinologist might be helpful, this may be a concern better addressed by her regular pediatrician or even a pediatric pulmonologist. A pulmonologist (and some general pediatric offices) will have a simple pulmonary function testing machine and can put a patient through an exercise protocol or other means to challenge the patient to gently try to reproduce the symptoms and see how the lungs respond.

DS