October 26, 2005
Hypoglycemia
Question from New Caledonia:
I have a three year, 10 month old daughter who was diagnosed with hypoglycemia over a year ago. Her low blood sugar occurs mostly at 10:30 a.m. (breakfast at 6:30 a.m. no morning tea), but also after too much exercise or after a big sugar intake. After multiple analyses, she was first diagnosed with hyperinsulinemia but the doctor is rethinking this. He is asking for a second opinion at the moment.
One of the analyses showed a postprandial sugar level of 2.40 mmol/L [43.2 mg/dl] and an insulin level of 122 pmol/L. We noticed that, from time to time, she would also have sugar levels before breakfast from 1 mmol/L [18 mg/dl] to 1.4 mmol/L [25 mg/dl]. After a lot of research on Internet, we thought it could be pre-diabetes. We told our doctor about it, but he doesn’t believe in it. I can’t help in thinking I’m right, that’s why I’m asking your opinion.
My daughter weighs 13 kg (29 pounds) for 95 cm (3 feet, 2 inches). There is a family history of type 2 diabetes. She’s active, although she tires quickly. She eats well, healthy meals at regular times.
Answer:
She certainly fits the diagnostic criteria chemically for hypoglycemia although you did not specify what symptoms occurred when she was hypoglycemic. With documented hypoglycemia and elevated insulin, by definition, this is an abnormal hyperinsulinemic condition. This could be a pre-diabetic condition and could also be a variety of other hyperinsulinemic states. You should be working with a pediatric endocrinologist familiar with this complex situation, I suspect. Avoiding concentrated sugar foods/snacks sometimes helps. Avoiding long periods greater than three hours without some food higher in protein/fat (and perhaps complex carbohydrates such as corn starch or similar complex carbohydrates) may also sometimes help. Home monitoring of blood glucose levels would give family members responsible for this child great information to know what is happening, whether or not emergency care is needed, etc. Please consult a pediatric endocrinologist as soon as possible since this is an urgent situation.
SB
