Question from California, USA:

My three and a half year old daughter recently had an OGTT done in-patient with an endocrinology specialty clinic. She weighs 34 pounds and was given 29 grams of carbohydrate to drink.

The doctors have confirmed her results to be abnormal but, honestly, do not know why. She continues to have symptoms of nausea, fatigue, intermittent frequent urination, thirst, and bed wetting. Home monitoring gives us a blood sugar range of 58 to 190 mg/dl [3.2 to 10.6 mmol/L]. She is very symptomatic under 72 mg/dl [4.0 mmol/L] with non-responsiveness, twitching, fast heart rate, hunger, irritability and sleepiness.

Her results are as follows:

Time
Blood Glucose
Insulin Level
Ketone Level
Lactic Acid Level

Fasting
88 mg/dl [4.9 mmol/L]
1.1 uIU/ml
3.12 mg/dl
2.2 mmol/L

30 minutes
107 mg/dl [5.9 mmol/L]
6.0 uIU/ml
unknown
1.1 mmol/L

One Hour
130 mg/dl [7.2 mmol/L]
12.0 uIU/ml
1.04 mg/dl
1.0 mmol/L

90 Minutes
95 mg/dl [5.3 mmol/L]
6.9 uIU/ml
.52 mg/dl
1.1 mmol/L

Two Hours
85 mg/dl [4.7 mmol/L]
<2 uIU/ml .83 mg/dl .9 mmol/L Three Hours 96 mg/dl [5.3 mmol/L] 3.1 uIU/ml .73 mg/dl .9 mmol/L Four Hours 74 mg/dl [4.1 mmol/L] <2 uIU/ml 6.86 mg/dl .7 mmol/L Five Hours 72 mg/dl [4.0 mmol/L] <2 uIU/ml 12.17mg/dl 1.0 mmol/L At three and a half hours, she was very symptomatic and her blood sugar was 68 mg/dl [3.8 mmol/L]. When they did the four hour testing, the also measured her cortisol as 4.7 ug/dl and her growth hormone as 2.8 ng/ml. She also had clinically low alanine and ornithine on her amino acid panel. She is scheduled to see a metabolic specialist in June but continues to have problems and no one seems to be able to help her. She is now taking raw cornstarch at night and before preschool, per the metabolic department, until she can be seen. What is your opinion on the blood ketones rising after the three and a half hour mark? Are her insulin levels normal throughout this test? How about the cortisol and growth hormone during her "crash;" should they be higher? Why does she NOT recover? Does this sound like a pre-diabetic condition? She is negative to all antibody testing thus far.