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November 7, 2004

Diagnosis and Symptoms

Question from Prescott, Arizona, USA:

I have a 13 year old with ketotic hypoglycemia but, now, my 9 year old son has been tested for diabetes. He has an underlying glycosylation disorder. He was first checked because he has acanthosis nigricans and his blood sugars range from 46 to 350 mg/dl [2.6 to 19.4 mmol/L]; they fluctuate daily. The first doctor said he has type 2 while the endocrinologist says it is reactive hypoglycemia. We tried to settle this with a glucose tolerance test that only seemed to makes things more confusing. I hope you can help. His OGTT is as follows: Time Blood Glucose Insulin 9:15 a.m. 87 mg/dl [4.8 mmol/L] 3.5 9:45 a.m. 128 mg/dl [7.1 mmol/L] (H) 27 (H) 10:15 a.m. 108 mg/dl [6 mmol/L] 16 (H) 10:45 a.m. 136 mg/dl [7.6 mmol/L] 50 (H) 11:15 a.m. 90 mg/dl [5.0 mmol/L] 14 (H) 11:45 a.m. 46 mg/dl [2.6 mmol/L] 1.7 12:15 a.m. 83 mg/dl [4.3 mmol/L] 1.6 A follow up insulin test showed the following after a 12 hour fast: 10:45 a.m., 50 11:15 a.m., 14 11:45 a.m., 1.7.

Answer:

This is much too complicated for an easy e-mail answer. You need to go back and have a prolonged consultation with your endocrine team. If necessary, have your questions written out ahead of time so that they can be answered. It may be that the exact answers are not known and that only time will help sort this out. Getting your child to a more idealized weight will only help. Daily exercise will only help such metabolic perturbations. Avoiding simple sugars and saturated fat excess, as well as trans fatty acids, also can only be helpful.

SB