My three year old daughter had an episode last week where she was unable to talk or walk after a long night’s sleep. She was lethargic. I forced her to drink some orange juice and eventually she came around, ate a TON of food and felt better. For two days afterward, her breath and bowel movement’s smelled sweet. I didn’t test her urine.

Several times in the past, she has had large ketones in her urine, especially with illness. I suspect she did this time as well, although I didn’t have any test strips. She has never had glucose in her urine.

She is seeing a doctor at the Children’s Hospital of Philadelphia (CHOP), but was originally going to see someone at Hershey. Hershey said CHOP is better equipped to handle hypoglycemia. How will they know if it’s diabetes, hypoglycemia or neither? If it’s hypoglycemia, what are the chances that it will progress to diabetes?

The sweet smell is likely the fruity odor of ketones on the breath. This usually means the body is burning fats. Old fashioned acetone nail polish remover is the same smell and chemical. It could be that she becomes hypoglycemic overnight and then switches to fat metabolism and, thus, the ketones in the blood/urine. The folks at CHOP headed by Dr. Charles Stanley are excellent at such evaluations. In the meantime, you may want to be sure that she always has something with protein and fat as a bedtime snack since this will help her have sufficient food provided overnight. If she has any kind of illness, then you may even want to wake her up and give her some peanut butter, salami, meatballs, etc. something with protein and fat that will sustain her energy needs while you await the formal evaluation. Some types of hypoglycemia can progress to diabetes as the pancreas goes from overproducing insulin to underproduction; others are not related to diabetes at all.

SB