September 26, 2006
Diagnosis and Symptoms
Question from Tennessee, USA:
My two year old has a CHD, a fundoplication, and has a g-tube. She eats by mouth during the day and gets one small 8 ounce can of milk overnight. She starting sweating badly after eating and a lot at night. She also gags a lot, too, but the fundoplication might have something to do with that.
She has had episodes of low blood sugars, in the 30s and 40s mg/dl [1.7 to 2.7 mmol/L]. Last week, she had an ACTH stimulation test done with other blood work. Her fasting glucose was 89 mg/dl [4.9 mmol/L]. She ate at 10 a.m. Twenty minutes later, her blood sugar was 225 mg/dl [12.5 mmol/L]. The doctor instructed me to monitor her blood sugars 30 minutes and one hour after meals. Her morning readings are from 145 to 189 mg/dl [8.1 to 10.5 mmol/L], but are 115 to 132 mg/dl [6.4 to 7.3 mmol/L] the rest of the day. That is with limited carbohydrate and sugar intake of less than 20 grams of carbohydrates a meal per request of the doctor. If she eats a pudding, her readings are in the 190s mg/dl [10.6 to 11 mmol/L] or so.
My daughter does ask for water often, but she does not have excess wet diapers. I will be checking back with the doctor next week to give the glucose results and go from there. Any input would be helpful.
Answer:
I don’t know what you mean by “CHD” (Congenital Heart Defect?).
There is a phenomenon fairly well established that occurs in some people after they have undergone stomach manipulations, such as a fundoplication, that is called “dumping syndrome.” Dumping syndrome infers that food is transiting out of the stomach into the intestines a bit too quickly which, in simple terms, gets the hormonal timing off in terms of those chemicals that help control the release of insulin. This leads to bursts of insulin and lowering of blood glucose too quickly.
I don’t know that your child is having dumping syndrome, but I’d guess this is what your doctor is thinking about. It does not explain the higher glucose readings you’ve come across, though.
So, I think the carefully performed home glucose monitoring is very reasonable at this point. Be sure you are using your glucose meter correctly with the correct dates and times set up; code the correct test strips (a few meters do not require this step), and use a control solution now and then to double-check results.
There is an easy and not so expensive medication for the child to take with meals that can help, if this is dumping syndrome. Good luck and let us know.
DS
