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Question:

From Upper Gagetown, New Brunswick, Canada:

My five year old daughter has had ketotic hypoglycemia for about two and a half years now. She first started showing symptoms by wetting the bed, not being able to get to the washroom fast enough and then started having shaky spells mostly in the morning when she was starting to eat. She was hospitalized and tests were done to confirm, but to their amazement she has low and high readings. After a low reading, they gave her an injection of glucagon, and her sugar reading went even lower; next time it did come up a little bit. She mostly has low readings, but they can come at any time of the day now. Sometimes it is hard to get it to stay up. I make sure she has carbs with protein to try to maintain it, but it doesn't seem to make any difference. My concern now is that she is having these days more and more often. She has been very hungry for the last two weeks and wetting herself all over again. I thought she may have a bladder infection, but urine tests were clear.

I have taken her to her pediatrician every six months for follow-up who feels she should outgrow it soon, but we do not feel that way, we think she is getting worse. She saw a pediatric endocrinologist when she was first diagnosed, who confirmed that it was hypoglycemia, but said it was rare to have some high readings as well.

Lately, her urine is sweet smelling and her readings are in the normal range, but she is still shaky at times, and it is hard to get a good reading most of the time because all she wants to do is eat. She weighs 45 pounds, which isn't bad, I don't think.

What should we do next? I don't want to put her through all those tests again, but I think we need to find a new pediatrician who understands we need more answers. She is to start school in September, and I would like to have this under control.

Answer:

You seem very frustrated. I suggest that you share your concerns with your pediatrician and ask again for a follow-up referral to the pediatric endocrinologist.

In my experience, it is uncommon for children with ketotic hypoglycemia to have episodes during which they can't control their bladder function and then have accidents. Does she have a change in her thirst and other daytime bathroom/urinary habits? It is not uncommon for ketotic hypoglycemia to not respond well to glucagon. A good glucose response to the glucose-releasing action of glucagon more reflects that their is stored glucose, often due to excess insulin or to other liver problems.

Ketotic hypoglycemia is usually seen in thin children who use up their stored energy/glucose quickly. The treatment tends to be frequent small meals with complex carbohydrates and protein and to avoid prolonged time (more than eight or so hours) of fasting

DS

DTQ-20020430173217
Original posting 23 May 2002
Posted to Hypoglycemia

  
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Last Updated: Tuesday April 06, 2010 15:09:34
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