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March 18, 2001

Diagnosis and Symptoms

Question from St. Charles, Illinois, USA:

My daughter occasionally wakes in the morning with horrible tremors, to the point where she can barely hold a glass of water. She is also extremely nauseous and can vomit up even crackers or toast. She will also be very pale and clammy to the touch. My brothers and I suffered through this throughout most of our childhood. An episode will occur periodically although I have noticed some patterns. Her appetite will increase dramatically for about a week leading up to an incident and quite often before an episode, and her sleep patterns will be disrupted, usually by special occasions, excitement, etc. The doctors always just diagnosed hypoglycemia, but don't seem to take into account the sleep changes that may cause these episodes or the fact that her nausea can be quite severe. We've become rather diligent about making sure that she has snacks before bedtime, but last night she actually woke at 1:30 a.m. with tremors that were so bad we thought she might have a seizure so we called the paramedics. On their advice we took her to the ER where her blood sugar tested within the normal range. For dinner last night she ate a lot (scrambled egg, pasta, two bowls of cereal). She is usually a picky eater and although tall she is quite thin. I am taking her to a pediatric endocrinologist per my pediatricians suggestion, however he seems to be genuinely bewildered at the severity of her symptoms, and we are quite concerned. Could this be a prelude to diabetes or something? Although no one in either family has diabetes, as I said before, my brothers and I suffered from these symptoms throughout childhood.


The symptoms are not typical of diabetes and do not suggest it. The symptoms are suggestive of hypoglycaemia, but this is a not a diagnosis, simply a symptom of a problem that needs to be investigated. However, a normal blood sugar when she has symptoms tends to exclude this.

You are right to take her to an endocrinologist. A diagnostic fast may be the only way to tell whether or not this is a metabolic problem.