August 31, 2002
Diagnosis and Symptoms
Question from Asheboro, North Carolina, USA:
My seven year old son has several problems including occipital epilepsy, apnea/hypopnea, sore legs in the morning and tingling in his hands and feet. His neurologist suggested checking his blood sugar levels to see if this could be part of the problem so his pediatrician ordered a five hour glucose tolerance test:
Time
Blood Glucose
Fasting
87 mg/dl [4.8 mmol/L]
One- half hour
138 mg/dl [7.7 mmol/L]
One hour
127 mg/dl [7.1 mmol/L]
Two hours
131 mg/dl [7.3 mmol/L]
Three hours
58 mg/dl [3.2 mmol/L]
Four hours
84 mg/dl [84 mmol/L]
Five hours
78 mg/dl [4.3 mmol/L]
I’m a bit confused about the results and what we should be seeing with a home glucose monitor. Obviously, I am very concerned about the drop from 131 mg/dl [7.3 mmol/L] to 58 mg/dl [3.2 mmol/L] because he began to cry a lot and was very pale between hours two and three.
Normally, he’s hungry the first thing out of his mouth in the morning, he wants a snack the last thing before going to bed, and he has an enormous appetite. He frequently has to urinate in the middle of the night, however I don’t see the unquenchable thirst that everyone talks about with diabetes. He also has days when his cognitive abilities are impaired (i.e., He can’t focus while doing his schoolwork. He will forget things he’s already learned or forget things he did the night before, and one day he put his breakfast dishes in the pantry instead of the dishwasher without knowing what he had done.).
Can you tell me which way we should go from here regarding his blood sugar levels? I checked his level here at home before dinner which was 90 mg/dl [5 mmol/L], and then two hours later (just before bed) it was 122 mg/dl [6.8 mmol/L].
His doctor suggests seeing an endocrinologist for further testing. Do you think his symptoms and these readings warrant this?
Answer:
Unfortunately, it looks like the test did not include insulin levels. These would be needed to determine if the drop to 58 mg/dl [3.2 mmol/L] is significant or not, in my opinion. Such drops occur in many people (kids and adults) and is within the wide range of normal expectations. We usually do not diagnose significant hypoglycemia with blood glucose readings of 58 mg/dl [3.2 mmol/L].
None of this sounds like diabetes to me. A consultation with a good pediatric endocrinologist/metabolism expert may help. Sometimes amino acid or mitochondrial defects may cause similar symptoms and problems, even with some hypoglycemia.
Whether or not he has hypoglycemia. making sure that he avoids simple carbohydrates at snacks and meals often helps and stops such problems as you describe, in my opinion. Also, each meal should have some protein/fat as should each snack, and he should never go more than three hours without such a protein/fat snack or meal. This solves the problem, whether or not one diagnoses true hypoglycemia, more than 95% of the time.
Also, please remember that testing with home blood glucose monitoring equipment is only accurate plus/minus 10% so that a blood glucose of 58 mg/dl [3.2 mmol/L] on a home meter could be in the 60s [mg/dl, 3.3 mmol/L] and still produce the same result. On lab standardized hospital type equipment, such variability is much less and therefore the lab equipment is usually much more accurate.
SB
