December 16, 2002
Diagnosis and Symptoms
Question from Rancho Santa Margaritta, California, USA:
My three and a half year old daughter frequently wakes up at night practically incoherent and complaining of pain in her legs. Last night was the worst — she woke up four times and complained she could not get comfortable. Two years ago, we had to take her to the hospital because we could not wake her up in the morning. The only thing that the hospital could find was a low blood sugar at the time of the incident. After food and hydration, she came around. We had a similar incident, but not as severe, about six months ago. She went to bed at 5:00 pm and could not be woken up until morning.
We saw an endocrinologist at the local children’s hospital who said that all the testing looked normal. We purchased a monitor and have checked her three different times when she said she was moody, almost unreasonable, and complaining of leg cramps, all of which were normal. We have not seen any recent severe symptoms that would cause us to take her the hospital. However, she does have moments of rage and frustration, and we are concerned it is linked to low blood sugar levels, but don’t know if we should seek a second opinion. We have not be able to duplicate the low blood sugar levels she had two years ago. Was this an isolated occurrence?
What if there is something going on, and we are not taking the corrective steps to correct the problem? Is there a diagnosis? If there is, what is the treatment? Is there even a problem at all? At The last doctor visit, we were informed to monitor her levels when we think she may be low. So far we have tested her, and they appear to be normal. The doctor’s advice was to wait until they are low again and have the blood drawn at the time to determine exactly what is happening. Do you think we should be doing anything else at this time? Is it possible that our child is just moody, has growing pains, and had an isolated case of low blood sugar two years ago?
Answer:
Low blood glucose, per se, does not usually lead to muscle cramping. It sounds as what you are describing with her times with difficult awakening, is a generally benign, temporary type of low glucose called ketotic hypoglycemia which is more common in toddlers, generally thinner children, and events that are more often associated with prolonged times between meals. Most of the time, these are addressed with limiting the amount of “simple” sugars, but increasing the amounts of complex carbohydrates. Adding extra protein to the diet often helps.
So-called “growing pains” of which you describe more often occur late at night in children who have been particularly active. They usually resolve with a bit of massage and perhaps warm, moist heat using a warm-water-bottle or careful use of a heating pad. You might try to prevent such events by having the child soak in a warm bath before bed. Some families find that children’s Motrin or similar medications are helpful.
Relatively prolonged elevated blood glucose in a person known to have diabetes can sometimes lead to muscle cramps, due to low potassium levels. Indeed, low potassium from other causes can lead to this. However, those are actually rare concerns. I think that common things happen commonly. You will likely wish to talk with your pediatrician.
DS
[Editor’s comment: Growing Pains.
SS]
