From Fort Wayne, Indiana, USA:
This last weekend. on the second day of a swim meet, my ten-year-old son had a violent incident with his coaches and, consequently, was removed from the team for the short course season. To give you some background: Before this school year/swim season began, we would eat supper at 6 p.m., but quite frequently, my son would get extremely agitated, aggressive, and angry before supper was ready. Sometimes, we would have a hard time getting him to sit down and eat. As he got food into his system, he would calm down into his normal happy self. My husband once commented that on the day he fixes dinner at 4 p.m., our son is fine. So, when school started and swim practice started (running into suppertime), I moved supper up to around 4:15, so that he could eat and get food through his system enough to practice without being too full. We would have occasional problems with locker room issues after practice, but nothing major, until this last month. I was a little slack about supper before practice and sometimes would just do a snack and eat afterward. We have had major locker room issues this month, but I don't know if the problems correspond with the snack night or not.
This weekend, we drove from Ft. Wayne to Indianapolis leaving the house a 8 a.m. My son had a half of a ham sandwich that morning before leaving, two apples around 10 a.m. and he had Propel to drink at the meet. He was fine Saturday. We didn't eat supper until about two and a half hours after he'd finished swimming. He had a hamburger, one-half of his fries and a chocolate malt. We went back to the hotel room and he went to the hotel pool and played games with his sister and dad for about 45 minutes to an hour. When they were done, we went to bed. The next morning, he woke up said he didn't sleep well and said he was cold. When I felt him, he was freezing cold. I curled up with him under the down blanket, put socks on his extremely cold feet, and had him wear his sweatshirt and jeans to try to warm up. He didn't really want to eat much, two Pop Tarts, then two chocolate milks and a hash brown order an hour later. About 10:45 a.m., we were getting ready to go and he very angrily let us know that he wasn't swimming. He has only missed practice because of our schedule and is very serious and looks forward to swimming at practice and meets. I thought that he was just upset because he thought we would be going to the different fun things Indianapolis has to offer as a family. His dad had been in Hawaii for the month previous and it was our first weekend with all of us together. So, I took him, fuming and fighting (physically pushing at me) with me, to the pool and told the coach that he didn't really want to swim today. We both thought that he would be fine once he was in the water. He swam, but when he looked at us in the stands during warm-up, he was clearly not happy. He was also still very cold, wrapped and shivering in his towel; his lips were a little blue. All the kids said the water was cold. I sent his coat over to him with one of the coaches to keep him warmer until his heat was up. He took it and went to the locker room, changed and left to come to us to leave. His coaches had no idea where he was. My husband had gone to go check on him when we saw he wasn't on the bench and found him coming to leave. He took him back and changed him to his suit to swim his first heat. He did really well. Afterwards, he went back to the spot the coaches had put him and pulled his knees up to his chest and just sat there not watching anything and looked very angry still. He did try to leave once more and the coaches pulled him back and were trying to talk to him when my husband, now back in the stands, said, "I wonder if he is hungry." I got up to go see if I could get him to eat and before I could get there, he was swinging and kicking at the coaches. When I got him to the hall to change, he was talking about suing the coaches and the team and just really really mad. He didn't want to be touched or talk about his behavior. We left the meet and got food as soon as we could. After he ate a sandwich, chips and a Sprite, he was fine, but thirsty, wanting water. When I talked with him about the day, he just said that he was really tired. I told him that we don't hit and kick just because we are tired and that he couldn't have been too tired because he knocked eight seconds off of the one event he swam in that morning. He was totally shocked by that revelation and said he did not remember the coach telling him that.
After we got home, my husband I discussed the situation and family history and decided to see if our son has hypoglycemia. He had a glucose tolerance test on February 8. His fasting blood sugar was 87 mg/dl [4.7 mmol/L], then they had him consume an orange drink. They took blood at one hour and at two hours. By then, my son was saying he was starving and really thirsty. I had taken a water bottle and some pistachios for him to snack on after until we got home. When we got home, he immediately went to the couch and laid down and ate some pizza, some bacon, some peanut butter and some cookies. He was very pale and looked like he had been through the ringer. He ended up drinking about 48 ounces of water by 1 p.m. He then did some Dance Dance Revolution, but said he wasn't felling well. About an hour or so later, he wanted a snack, said he felt hungry and a little angry. I told him that he needed to get food when he started to feel hungry, before he got angry.
I called for the test results, which they said were normal. At one hour, he was 140 mg/dl [7.8 mmol/L] and at two hours, he was 100 mg/dl [5.6 mmol/L]. I still want to take him to the doctor to discuss the possible hypoglycemia. I did weigh him today at the suggestion of the hospital diabetes person to whom I spoke. But, what else should we do or ask our doctor to do?
I would appreciate any guidance that you have on getting through this maze and getting answers. My son wants to swim and I want to know what caused this episode to have some explanation for the coaches and parents who are "concerned" for safety issues.
It could be hypoglycemia, unlikely the most serious type of hypoglycemia involving an insulin producing tumor. It could be a forerunner to diabetes or could just be exercise induced changes in the autonomic nervous system. The types of food and snacks that you are provided do not seem well balanced or healthy and are high in simple sugars. This would suggest that extra activity and/or meal delays could be hypoglycemia related or should at least be considered.
The standard glucose tolerance test that you had done will never answer such questions and is almost never done any longer. If one wanted to check for hypoglycemia, it would be easier to get a blood glucose meter and do home monitoring before and after meals for a week and see what the results are. Most of the time, there is no defined hypoglycemia (blood glucose levels below 60 mg/dl [3.3 mmol/L] with concomitant symptoms that get better within a few minutes of sugar intake). Having said that, the only way to know for sure is to do more specific testing. Most kids and adults get better with such reactive hypoglycemia if they avoid simple sugars and always have something with fat and protein every three hours. Therefore, even if there might be dropping glucose levels, the food provided every three hours prevents the symptoms and/or the dropping values. In my experience, this works about 95% of the time and only in the remainder does one need to do more testing.
If a glucose challenge is to be done, you need simultaneous insulin levels and also blood glucose tests at least every 30 minutes for at least four hours. The results you obtained eliminate diabetes as a possibility, but not much else can be ascertained.
I would recommend a consultation with a pediatric endocrinologist familiar with pediatric hypoglycemia issues.
Last Updated: Tuesday April 06, 2010 15:10:12
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