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Question:

From Puerto Rico:

Our 6 year old daughter has just been diagnosed with hypoglycemia, based on the following tests: 4-hour GTT with results 77 mg/dL fasting, 128 mg/dL at half hour, 79 mg/dL at one hour, 60 mg/dL at two hours, 67 mg/dL at three hours and 69 mg/dL at four hours; insulin levels were 3.8 uU/ML fasting and 0.75 uU/ML at two hours; negative for glucose in her urine.

For the past few (about four) months, our daughter has experienced mild headaches which last a few minutes, but she has just been diagnosed with astigmatism and needs glasses. Sometimes she has been a bit moody, and gets hungry and thirsty frequently during the day, but does not eat a lot. She doesn't eat to much sweets. She also has complained of stomach aches.

About two weeks she complained of feeling like she was trembling, and she felt cold to my touch, but she started to eat and felt better within five minutes.

Currently she is having three meals and two to three snacks, and no sugar at all.

Our questions are: Aren't the numbers on the GTT too high to be hypoglycemia? Doesn't the insulin level has to be high? We don't understand how her blood sugar got low so fast if her pancreas didn't produce too much insulin, which by the insulin test, we understand it didn't. Is this condition dangerous? Is there a safe amount of sugar we can allow her to eat with her meals? Should we ask for any other tests to confirm this diagnosis, or should she be tested again in the future (and when)? Could there be any other type of condition that can cause this scenario?

Answer:

It doesn't sound like your daughter has significant low blood sugar. In my experience, a glucose tolerance test is rarely helpful in the situation you describe. The most helpful test is a blood test drawn when your child is symptomatic, processed properly, and sent to a laboratory. If low, further evaluation is indicated.

No, you don't have to have excessive insulin production to have true low blood sugar. In children, hormonal deficiencies such as growth hormone or cortisol deficiency are more common causes of true low blood sugar. These hormones are necessary to pull stored sugar out of the liver when your child goes a long time without eating. Usually these children have symptoms with exercise, fasting, or illness. Some children have some mild symptoms without true low blood sugar a few hours after eating if they eat foods high in sugar. This is not dangerous, but can be annoying and can be treated by eating frequent, low carbohydrate, high protein meals and snack.

You should discuss these results with your own physician. If there is any question, perhaps you could see a pediatric endocrinologist.

TGL

Original posting 30 Sep 1998
Posted to Hypoglycemia

  
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Last Updated: Tuesday April 06, 2010 15:09:00
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