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August 27, 2001

Diagnosis and Symptoms

Question from Burlington, North Carolina, USA:

My five year old son who will wake up sometimes extremely pale, and if I let him go back to sleep, we cannot wake him. There is a strong history of diabetes in my husband's family and hypoglycemia in mine. His grandmother tells us that he acts like his uncle did when he was this age, and he was diagnosed at 18, after his blood sugar bottomed out I really need help or some ideas for guidance because this has been going on for three years. My son has been tested for diabetes and hypoglycemia, but the doctors here don't want to run the glucose tolerance test on him because of his age.

Answer:

I doubt that your son has diabetes at this time. Diabetes is associated with elevated blood sugar. The typical symptoms of non-treated diabetes in young people is increased urination, increased thirst, and often changes in appetite and weight loss.

Your description of your 5 year old son sounds more consistent with low blood sugar. A common presentation is as you describe whereby the child is difficult to awaken in the morning — especially if there has been a prolonged period of time since the last meal. (Not uncommonly this occurs on Sunday mornings, as the family “sleeps in.”) Usually, such children are rather thin.

This can be easy to diagnose and does not usually require a glucose tolerance test. Sometimes, we have families check the blood glucose during the episode with the same type of meters that people with diabetes use to document the sugar (glucose) level. If your doctor is uncomfortable with assessing your child, you may wish to seek the advice of another pediatrician or pediatric endocrinologist who works with such patients. The good news is that this type of low blood sugar situation is one that most patients outgrow. There are other more serious possibilities but a good evaluation can help screen for those.

As a stop gap measure, you might consider assuring that your son has a bedtime snack which contains a complex carbohydrate (starch, cornstarch) and or one with protein. I like to have patients give a packet of Carnation Instant breakfast with milk.

DS