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July 14, 2003

Diagnosis and Symptoms, Hypoglycemia

Question from Newark, Delaware, USA:

On two occasions, my 10 year old son has awoken in the morning feeling sick. His symptoms are those of hypoglycemia (sweating, confused, nausea, weak, feeling of fainting). This only happens first thing in the morning after he's been asleep all night, and have given him soda, or some form of sugar to bring him back. Do I give him some form of sugar before bedtime? Isn't this an underlying symptom of a bigger problem? I recognized the problem immediately, but when I took to the doctor, they find nothing, and I am getting no help from the doctors. I feel that because he has Medicaid and he's a child, they aren't giving him enough attention. What do I do to make them see the problem before this happens again?


In short, a blood sample needs to be drawn when he is actually having symptoms to decide if he is truly having a low blood sugar. If he is, he needs a complete evaluation by a pediatric endocrinologist.

There are many excellent medical centers that accept Medicaid insurance. I do not think your child’s symptoms are being ignored because of his insurance. I would ask your pediatrician for a referral to a center with a pediatric endocrinologist.

Additional comments from Dr. Donough O’Brien:

It is clear that you are concerned that your son is having nocturnal hypoglycemia, and that this in turn might be an index of type�1 diabetes. However, I actually think that both problems are very unlikely, and although a simple fasting blood sugar would clear the matter up and reassure you, you may be reluctant to press the matter at this stage especially as your son seems otherwise well.

I asked one of our dietitians for a bedtime snack recipe that should maintain blood sugar levels overnight; but if the symptoms continue you must go back to the pediatrician. Here it is: “Stir together 3/4 cup peanut butter, 3 tbsp honey, 1/4 cup cornstarch and roll into balls of about 1 tbsp size. Then roll in crushed cornflakes, flatten and chill. Give one of these cookies at bedtime.”

Additional comments from Dr. Stuart Brink:
Could be hypoglycemia. You should discuss with your pediatrician or get a

consultation with a pediatric endocrinologist to try to see if this is true, how you might monitor him at home and specifically what you might do with his food to try to prevent such episodes. Most of the time, such cases, if hypoglycemic, can be prevented with appropriate food choices.