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Question:

From Grove City, Ohio, USA:

My 16 year old son is a wrestler and also plays football, both of his grandfathers have diabetes, and I was diagnosed with hypoglycemia as a teenager. His sugar dropped to 40 mg/dl [1.1 mmol/L] once and we took him to the doctor, but we can not seem to get the extensive testing needed to confirm hypoglycemia. It is high stress wrestling time again, which is when the problems occur, and the trainers do not have a blood sugar test kit.

Last year, at the state sectional tournament, was his first big incident. He was clammy, pale, sweaty, dizzy and glassy eyed. Upon the suggestion of the doctor who saw seen him that day, we put him through the wringer of tests (heart ultrasound, blood tests), but the doctor only did one stick fasting glucose test. The symptoms seem to be appearing more often this year, perhaps because he is a his rankings/expectations are higher. He has been eating with the team and avoids high sugar drinks because they seem to make him vomit. He avoids candy and sweets to prevent highs that bring lows on meet days.

I have several questions:

  1. I need to find a doctor who deals with sports and sugar.
  2. I need to know what kind of diet would help prevent problems on a stressful meet day.
  3. What would be the best times for is to test his sugar to regulate it during the meets? (Sometimes the meets move fast and there may be less than 30-40 minutes between matches.
  4. What the symptoms are for low blood sugar during stressful exercise, so I can watch for them and educate his coaches too.
I know that I have a lot of questions, but I figure that it will take some time to get him to a specialist doctor. He has been to the pediatrician and family doctors, but nothing is working.

Answer:

There are a number of causes of hypoglycemia (low blood sugar) besides treatment of diabetes. We we urge you to read the following, and share the information with your son's physician.

By far the most common disorder of this kind is ketotic hypoglycemia which occurs in young children when the carbohydrate intake is reduced, often as a result of diminished appetite in a minor illness, to the point at which fat stores are needed for energy and ketones are produced.

Increased blood glucose levels from the absorption of carbohydrate are balanced by insulin; but three other hormones (epinephrine and glucocorticoids from the adrenal gland, and glucagon from the pancreas) share the responsibility for restoring normal blood sugars from hypoglycemia, either by the breakdown of liver glycogen or by the conversion of protein or fat to glucose (gluconeogenesis). Acquired and congenital deficiencies of the hormones mentioned above, as well as certain inherited metabolic diseases, can also cause hypoglycemia. Another hypoglycemic condition is called "reactive hypoglycemia" which is manifest by a fall in blood sugar causing symptoms during the period following meals.

Finally, it should be mentioned that many times, adults (and sometimes kids) have symptoms that seem to be about the same as hypoglycemia, which may have relief from food, but which are found to have completely normal blood sugar levels despite rigorous testing. This situation is seen as a normal reaction to severe stress, and sometimes in exaggerated form in disorders of anxiety or panic.

The possibilities are best elucidated though by an endocrinologist (for adults) or a pediatric endocrinologist (for infants and/or children) or by other specialists in inherited metabolic disease (usually be located at a medical school or major medical center) who has access to the sometimes complex laboratory support that may be needed.

WWQ

Additional comments from Dr. Tessa Lebinger:

Growth hormone deficiency can also cause low blood sugar, especially if combined with cortisol deficiency.

TGL

DTQ-20030202073533
Original posting 14 Mar 2003
Posted to Hypoglycemia

  
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Last Updated: Tuesday April 06, 2010 15:09:42
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