When my nine-year-old son is hungry, it is very urgent that he eat. He becomes pale, weak and his breath has a strange odor if he does not eat something quickly. As soon as he eats, he is fine and he no longer has the strange odor to his breath and the other symptoms. I was just wondering if this could be low blood sugar.

This is possibly low blood glucose. It could be a generally benign form called “ketotic hypoglycemia,” although that usually occurs in a younger child. Is your son particularly thin?

There are other possibilities. You should make an appointment with your pediatrician to relay your concerns. The ONLY way to prove that these episodes are related to your child’s blood glucose is to test his blood sugar during the spells. This involves an easy procedure with a home glucose monitor. These monitors are easy to use, but, if this is recommended, I suggest that you get some one-on-one instruction so as to not get irregular results.

If this were “ketotic hypoglycemia,” then additional testing of blood ketones (with a special home meter) or, for much less money, urine ketones, would be required.

DS