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August 4, 2000

Diagnosis and Symptoms, Hypoglycemia

Question from Wausau, Wisconsin, USA:

My son (21 months) was diagnosed with ketotic hypoglycemia a few months ago. He also has lactose intolerance and, possibly, fructose intolerance. He had high ketones one afternoon after a five-and-one-half hour nap. His sugar was 82 mg/dl (4.6 mmol/L) at the time. After that, he showed trace to small ketones for a couple of days. Also, he has been wetting and drinking a lot the past few days. Today, there are no ketones and the drinking/wetting has slowed but not back to normal. The endocrinologist didn't see him during these symptoms, and now symptoms are calming down. He has shown high sugar levels in the past when ill, up to 277 mg/dl (15.4 mmol/L), three-and-one-half hours after eating, and once it was 217 mg/dl (12.1 mmol/L) after six hours without food. His endocrinologist said not to worry, it isn't diabetes. His antibody test was negative. Is there some other diagnosis for him? Is there a chance it could be diabetes, or is there some other metabolic disorder it might be?


Ketotic hypoglycaemia is a not uncommon problem in young children. It is felt to be due to a lack of good energy stores, and usually corrects itself as the child grows and matures. It is not related to diabetes at all.

However, it is a diagnosis of exclusion and should be checked out to make sure that there is not a metabolic cause underlying. If you are concerned you should have him reassessed by the paediatrician.

Additional comments from Dr. Stuart Brink:

This is an abnormal situation you are describing. You are correct in wanting to work with a skilled pediatric endocrinologist to understand these abnormalities. Key questions: Is this ketotic hypoglycemia? Is this nesidioblastosis? Has anyone checked insulin levels when hypoglycemia occurred or when hyperglycemia? Which antibody levels have been checked and by which methodology? What happens when he is fed high protein/high fat foods every 3 hours religiously to his blood glucose levels and does this prevent the swings you are describing?