March 7, 2005
Hypoglycemia
Question from Downers Grove, Illinois, USA:
My 21 month old daughter has experienced several “episodes” in the past couple of months and they seem to be becoming more frequent. She will have a meltdown, crying, screaming, etc. for no apparent reason, sometimes upon waking from her nap. She will be shaking and combative, sometimes for as long as an hour. Because they often happen after she has eaten less than normal and/or has been more active than normal, I have offered her food and drink which she has adamantly refused. When nothing else helped, I have forced her to eat something with sugar (ice cream, sorbet, even glucose gel). Each time, within minutes she is fine, happy and laughing.
My father is a type 1 diabetic, diagnosed in his late 20s, and I have been told I have borderline hypoglycemia. It was low during one point on a three hour GTT (glucose tolerance test), but was up to normal by the end of the test. My glucose levels were fine during pregnancy.
Our pediatrician has referred us to a pediatric endocrinologist. She said to keep my daughter’s sugar level up until we see the doctor, even giving a little candy every few hours, if necessary.
What kind of tests is the endocrinologist likely to run? Will results be available immediately? Do I need to be overly concerned until we see the doctor? My daughter has a cold and her appetite is poor. Are there foods we should encourage/avoid?
Answer:
It could be hypoglycemia, but going to the endocrinologist is a good idea. We would usually teach you to check your child’s blood glucose levels with a glucose meter to document what you are seeing and see if there really are blood glucose levels below 60 mg/dl [3.3 mmol/L] during these symptoms. Often, such hypoglycemia can be prevented with a meal plan that generally avoids simple sugars but has protein and fat every three hours. Ice cream, with all its fat, is good as is peanut butter and cheese; the high fat food choices are the key to make these foods “last.” Sometimes hypoglycemia can precede the development of type 1 diabetes so, this is also something to review with the endocrinologist during the consultation. The exact tests that might be done depend upon a detailed systems review, medical history and physical exam as well as family history but may include glucose, insulin, pancreatic antibodies as well as celiac and thyroid testing. Sometimes growth hormone and adrenal testing is also included when considering hypoglycemia.
SB