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March 10, 2006

Diagnosis and Symptoms

Question from North Carolina, USA:

My seven year old son had passed out once when he was five and again when he was six with belly pain, headaches, dizzy spells, fatigue, nausea, a very pale look and "hot flashes." He has most of these symptoms after eating! We saw a heart specialist who said he was fine. We saw an endocrinologist who now says he is fine. We had his A1c level checked and it was 4.0, but he was having blood sugars of ranging from 50 to 350 mg/dl [2.8 to 19.4 mmol/L]. We have checked for an adrenal tumor, pituitary tumor, and celiac disease. About another thousand tests have been run, all of which have been normal. The only thing we have got was that his Vanillylmandelic Acid (VMA) in the urine was elevated slightly. We also did a test where they put blood sugar monitor in him and tested over a period of three days. This showed high blood sugars after every meal, up to 200 mg/dl [11.1 mmol/L], which I was told was normal. Also, on the last day, his fasting blood sugar was 125 mg/dl [6.9 mmol/L], but they said it was okay because it was only for one of the three days. He has had a six hour glucose tolerance test. At the four hour mark, my son passed out with a blood sugar of 65 mg/dl [3.6 mmol/L]. They also have done a 24 hour fasting on him and on which he did great up until he was allowed to eat. At that time, he had one of his spells (dizziness, almost passing out, went pale, and was confused). Could this be pre-diabetes? We see a gastroenterologist on March 9. Do you have any ideas as to what might be going on? We just need some advice on where to go next or who to see and what questions to ask.

Answer:

That’s a lot of tests and there is not much conclusive from your letter. Blood glucose ranges as you report are not normal but could represent problems with how the intestinal tract empties and provides food – sometimes overwhelming the pancreas and insulin system and sometimes being too sluggish. Many of the patients that I have seen with such problems respond extremely well to a diet that limits all fast acting sugars completely, even fruits and juices and provides food or snacks every three hours very strictly. All such foods and snacks should have some fat and protein and this would then provide smoother food to the body, fewer hormone swings, etc. I would be interested in a formal gastrointestinal opinion. Food allergies in the intestinal tract sometimes appear like this as does celiac disease. Other problems could be related to the autonomic nervous system, but this is difficult to diagnose and treat. You may want to consult the specialists at Children’s Hospital of Philadelphia who have a particular interest in such disorders.

SB