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March 22, 2010

Diagnosis and Symptoms, Hypoglycemia

Question from Hardwick, Vermont, USA:

My son, born in November 2007, was diagnosed with mastocytosis in August 2008. Not much is known about this disease. Anyway, every now and then I noticed that he was shaking, but I didn't think much about it until yesterday. When he got up in the morning, he was shaking, pale, and fussy (not usual) for about 30 minutes or until he ate and drank chocolate milk. The same thing happened after an unusually long nap and then again this morning. I took him to the doctor two and a half hours after lunch and his blood sugar level was 169 mg/dl [9.4 mmol/L]. My mom, brother, father-in-law, and sister-in-law all have hypoglycemia but the doctor said he has never heard of a toddler having hypoglycemia even though he has the symptoms. I am testing his blood sugar level in the morning for the next week and going back to the doctor. I guess my questions are: Could this be mastocytosis related? Do toddlers get hypoglycemia? Do you have any suggestions?


It seems like your doctor is incorrect or did not explain fully. Anyone can get hypoglycemia although is it much more rare than people’s complaints. Lots of people have symptoms that are like hypoglycemia but it usually turns out their blood glucose levels are normal. The easiest thing to do is get a blood glucose meter and be taught how to check with a small drop of blood. This will give you an actual blood glucose level. If those symptoms recur, then you should do a blood glucose test immediately. If the values are less than 60 mg/dl [3.3 mmol/L], then this is hypoglycemia, by definition, and now the doctors have to either send you to a referral pediatric endocrinologist or do the complex evaluation themselves looking for a reason.

Treatment, if the blood glucose levels are low, is simple sugars: 4 ounces of orange juice, 4 ounces of skim milk (not fat containing milk), 4 ounces of regular sugar containing soda or other beverages. Sugar levels should rise within 10 to 15 minutes and symptoms should abate. This confirms that the hypoglycemia was present and responds.

Often, simple feeding change solves the problem. For example, you might want to avoid only simple carbohydrates and always having some protein and fat with the carbohydrates. Also, you might want to make sure that either food or snack is eaten every three hours. This is more of a problem with older children, teens and adults rather than toddlers.

I suspect that the mastocytosis is not related but you should ask his specialists what their experience has been.