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August 25, 2020

Hypoglycemia, Ketones

Question from Kansas, USA:

My five-year-old daughter recently had an overnight with grandma. When she woke up in the morning, my daughter’s heart was racing and she was shaking. Grandma took her to the Emergency Room, since I was out of town, where it was discovered her blood sugar was low, 51 mg/dl [2.8 mmol/L] and her ketones were high. We followed up with our primary caregiver who did blood work and said she’s not diabetic but had a hypoglycemic event. Her advice was to “feed her more.” She’s also referring us to an endocrinologist because my daughter’s TSH level was slightly elevated. Could the hypoglycemic event and the elevated TSH be related? Also, my research says she has ketotic hypoglycemia. Is “feed her more” the proper approach or should we have further testing done? Our doctor said it could be 6 months before the endocrinologist can see us and I’m concerned she’ll have another event in the meantime. I’ve been giving her a snack before bed and her fasting levels have been normal since this happened.


From: Dr. Stuart Brink

That’s a strange story. It is good that you are doing some home blood glucose monitoring to track what’s going on. Ketotic hypoglycemia in an otherwise healthy child would be somewhat rare. Unlikely a mild TSH elevation related but that needs to be tracked by endocrinology to see if the thyroid blood hormone levels go back to completely normal or if there is some underlying condition like Hashimoto’s thyroiditis that wouldn’t be associated usually with hypoglycemia, ketotic or otherwise. This also is an odd way for someone to present eventually with overt diabetes, but stay in touch with your doctors if there were unexplained weight loss, excess urination, bedwetting, excess thirst or if the home blood sugar levels were above 140 mg/dl [7.8 mmol/L]. It is especially important to check her blood sugar and maybe also urine ketones during any intermittent illness, virus or any other kind.

Ketones positive just means the body is not getting sufficient calories – but nonspecific. If associated with high sugar/glucose levels, it could be diabetes. If blood sugar levels were normal or low, it could be ketotic hypoglycemia. Adrenal insufficiency also rarely could be related. So, all of these things need to be checked out.

IF you cannot get an appointment with an endocrinologist sooner, call the endocrinologist’s office and ask to be put on a cancellation list. Usually, this means you can get seen within a week or so, maybe a little longer because of the coronavirus causing limited appointment availability. Your own primary care physician may also be able to make a call to the endocrinologist to try to expedite the process.