My daughter is three years old. One morning, she woke up lethargic, in a cold sweat and shivering. She could hardly walk and kept dozing, which is really unusual for her since she hardly even takes a nap. When we put her in the car to take her to the doctor, she started vomiting. She vomited about four or five times on the way to the doctor’s office, which was about 30 to 45 minutes away. By the time we got there, she was somewhat better. She had fallen and hit her head the night before, but only cried a couple of minutes so we thought nothing of it. We told the doctor about the fall and she said it was probably a head injury and to keep an eye on her. The next two days, she was really hyper and defiant. Since then, she has been moody, tired and just acts weird. She is always really thirsty and pees a lot. She has also always had strong smelling urine and is always red and sensitive in her vaginal area. She cannot drink 100% juice without getting diarrhea and often complains of a tummy ache. She also complains of her legs and feet hurting quite often. Could any of this mean she has diabetes? I am hypoglycemic and diabetes run on both my parents sides of the family.

Please see other Ask the Diabetes Team questions and read the Classification and Diagnosis of Diabetes.

The urinary symptoms are suggestive, but not diagnostic, of diabetes. The lethargy is not, at least not without preceding symptoms to suggest dehydration or other parameters of diabetic ketoacidosis. And, she would not have gotten better after vomiting.

HYPOglycemia could account for the transient lethargy. But, in the same vein as diabetes, you can’t make a diagnosis of hypoglycemia without measuring a blood glucose during the time of the “spell.”

Her intestinal intolerance to juice more reflects the sugar/osmotic load of the juice than diabetes. (Osmotic means that it pulls water: e.g. rice absorbs water and swells.) High concentrations of some substances “attract” water. This is why diabetics have to urinate a lot: the kidney filters out the excessive glucose, but the glucose attracts water. This is why diabetics urinate sugary urine rather than sugar cubes.”

A three year old is at higher risk for a condition called ketotic hypoglycemia. Your physician probably did tests when she was lethargic. If the glucose was very normal, she probably did not have hypoglycemia; but, on the other hand, it sounds as if she was already somewhat better at that time, so it does not EXCLUDE the possibility that her sugar was low during the spell. Be sure to ask your doctor about this issue.

Since common things happen commonly, a bit of lethargy and vomiting after a head whack certainly could have been the cause of this, although the timing is not classic. If this really was a case of hypoglycemia, is there some comfort that it will likely recur? The circumstances for ketotic hypoglycemia usually surround a longer period of sleep between dinner and breakfast after an evening when food intake was a little less than usual (or alcohol was consumed).

DS