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May 30, 2005

Hypoglycemia

Question from Arcadia, Michigan, USA:

My friend has three year old twins who where born early due to twin to twin transfusion. One of the twins (donor) had lung problems and digestive problems after birth. He was on oxygen for about three to four months at home. He also has a g-tube because he would not eat. He had GERD and had surgery twice. He went to a feeding clinic six months ago and came home eating orally. About three months ago, he was showing signs of low blood sugar. While at school, he became lethargic and bumping into things. EMS was called and his blood sugar was 49 mg/dl [2.7 mmol/L]. He stopped eating orally, so mom had to go to g-tube feedings, four to six times a day. She took him to see a endocrinologist and he was waiting for another episode of low sugar to get a blood test drawn. That was done yesterday. She spoke to the doctor today and he said he is worried about all the low sugars he has had. He thinks it may be genetic. If it is, why doesn't his twin have the same thing? His twin is healthy and growing. Can you explain a bit about the genetics of this? As far as I know, no immediate family members have or had hypoglycemia or diabetes.

Answer:

Identical twins would have different risks than fraternal twins. It could also be related to what is happening with the feedings, bowel motility, etc. The evaluation by the endocrinologist is critical to see if the insulin levels are too high or too low at the time of hypoglycemia. Also, there should be measurements of growth hormone and cortisol at that same hypoglycemia episode. This allows differential diagnosis to figure out the next testing needed. There also are many types of hypoglycemia and some of these are isolated and some are determined genetically.

SB