My six year old daughter has been diagnosed with ketotic hypoglycemia. Occasionally, she has moderate amounts of ketones in her urine when her blood sugars are very low. Her three hour oral glucose tolerance test results indicated that her insulin level reached as high as 91 while her blood glucose levels remained normal. What could be a probable cause for this?

Those insulin levels are very high if they are occurring at the same time as documented hypoglycemia Ketotic hypoglycemia just means that your child cannot keep sugar levels in the normal range when she is not eating, ill or some combination. Almost always, three meals and three snacks with high protein/high fat foods and avoiding simple carbohydrates/sugars will work. Usually, one needs extra sugary foods during illness every two to three hours, which prevents the low blood sugars from dropping. If the insulin levels are really high, then you should discuss this with your endocrinologist and see if they have looked for other insulin producing problems (tumors, pancreas abnormalities such as nesidioblastosis, etc).

SB