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October 6, 2008

Diagnosis and Symptoms, Hypoglycemia

Question from Maryland, USA:

My six-year-old son has always needed to eat a lot. As a toddler, he would get very angry, emotional and downright mean if he did not eat a lot. My pediatrician never discussed hypoglycemia with us; the school nurse did. My pediatrician feels that as long as we are controlling it with food, there is no need to get him tested because he has never has seizures or lost consciousness. He craves protein and can eat six eggs a day in addition to meals and snacks. He is not overweight or underweight. Should I have him tested and by what type of doctor? Also, could this have something more to do with protein than it does hypoglycemia? I am at my wits' end and cannot get out of the kitchen.

Answer:

Most kids/people with such mild reactive hypoglycemia do not need to do much more than eat three meals and three snacks and make sure that there are not very many simple sugars, plus always be sure that there are foods with protein/fat. This usually stops symptoms. We mostly do not recommend specific testing such as a prolonged glucose challenge unless this type of eating does not work. Sometimes, home blood glucose monitoring would be helpful to document that the blood glucose levels before meals and before snacks are normal or to document that symptoms are reflecting significantly low blood glucose levels. This would be easy to do at home for a week or so of intensive “profile” monitoring. If one does a prolonged oral glucose challenge, then it would be important NOT to restrict carbohydrates beforehand to get an accurate picture and also to include insulin levels as well as glucose levels every 30 minutes for a full 5 or 6 hours of testing. This is not such an easy test to get done. Consultation with a pediatric endocrinologist may be helpful if there are still further questions not solved by the meal planning.

SB