Hypoglycemia question about my 4yr old daughter Please - Hypoglycemia Message Board

claflamme · 06-13-2008, 11:59 AM

I have a 4 yr old daughter who saw an endo a few months ago because she has seen other dr's and I didn't know who else to take her to. She had been experiencing fatigue, sleepiness,extreme hunger, fevers (which thankfully now she hasn't had one since april). But she was getting a fever almost every month or so in spurts. But he thought that maybe the sleepiness was caused from hypoglycemia because when she wakes up from a nap (yes she still naps hasn't grown out of it yet) she is very sweaty and sometimes shaky (not every time but alot). So he set us up with a meter to test her 2X a week to get a base line or when she would have those symptoms.
All the reading were pretty normal except for a couple in the low 70's which were still normal but a little lower for her. But on 6/5 she woke up in the morning crying,very sweaty,confused,hungry(she didn't eat much the night before),She just didn't seem right,So I decided before I give her anythin I will check her level I hadn't checked it in a few weeks because they were all normal. I cleaned her finger like they told me and did it all right new stuff everything, it was only 49. So I gave her a few oz. of juice like the nurse said to if it is ever low. I Gave her some food too. And within a short amount of time she was fine,Like nothing was ever wrong.

I emailed the endo. and he said that 49 was borderline low. Well what do they consider low?
He said to check her every morning for the next week and email him the results. So I did.

The next week they were pretty normal except for on 6/10 she woke up the same way except the night before she had eaten a good dinner the night before and she was at 49 again. I gave her some juice and tried to feed her, but she would not eat ,but drank the juice then fell asleep for 2 hrs. I recked her after she woke up and it went up to 65. Not very good but better than 49

I emailed him all the results but got an auto reply that he is out until the 16th of june.

I do not recall her waking up or acting exactly like this especially twice in a week with such a low blood sugar reading.

I did read in her birth record that when she was about a day old her sugar level was also 49. That must be a magic number or something.

Any thought? I am at a lost.
Thank you

lilbit1973 · 06-13-2008, 09:41 PM

Well, I can tell you that my son had the same thing when he was about 10 months old. He was having random lows as well and his A1C was 4.7 (He's three yrs old now). They didn't really seem concerned about it though. His primary was all set to send me to an endo, but the endo said he wasn't concerned enough with the readings (his were anywhere from 48-55 at times, but mostly in the 70's). I was concerned b/c diabetes is rampant in my family and I have sugar issues as well. Have they checked her A1C? If not, they should. I would just keep an eye on it and you might want to start checking her 2hr post prandial sugars too (2hrs from the START of a meal) to see how they are running as well as her bedtime sugar. You might also want to start giving her a snack with some protein (peanut butter crackers or something) before she goes to sleep. Please keep us posted.

claflamme · 06-14-2008, 05:03 PM

How do you do the bedtime ones? She sometimes eats dinner later or has a snack before bed. The 2 hr Do you not give them anything in that time frame? How does that work? And they have not checked an A1C. But I did get a reply from the endo. He wants her level checked at the lab if it comes up low again.
Here is what it said let me know what you think or what he wants done:

I guess he is trying to confirm hypoglycemia is says in the letter to the lab

1. basic metabolic profile includingplasma glucose and electrolytes
2. blood lactate and pyruvate
3. plasma ammonia
4. Venous blood gas
5. plasma amino acid profile
6. Urine organic acid profile

If she does have a plasma glucose <50 mg/dl, immediately (before administering glucose) obtain the following studies:

1. Serum insulin (and simultaneous plasma glucose consentration)
2. Serum cortisol
3. Serum growth hormone (GH)
4. Serum free fatty acids (FFA) and B- hydroxbutyrate (BOHB)
5. Plasma total and free carnitine
6. Plasma acylcarnitine profile
7. Urinalysis for reducing substances and ketones; consider toxicology
screen
8. Urine acylglycine profile

Any ideas on what these labs are for?
Thanks

lilbit1973 · 06-17-2008, 09:34 AM

Quote:

Originally Posted by claflamme

How do you do the bedtime ones? She sometimes eats dinner later or has a snack before bed. The 2 hr Do you not give them anything in that time frame? How does that work? And they have not checked an A1C. But I did get a reply from the endo. He wants her level checked at the lab if it comes up low again.
Here is what it said let me know what you think or what he wants done:

I guess he is trying to confirm hypoglycemia is says in the letter to the lab

1. basic metabolic profile includingplasma glucose and electrolytes
2. blood lactate and pyruvate
3. plasma ammonia
4. Venous blood gas
5. plasma amino acid profile
6. Urine organic acid profile

If she does have a plasma glucose <50 mg/dl, immediately (before administering glucose) obtain the following studies:

1. Serum insulin (and simultaneous plasma glucose consentration)
2. Serum cortisol
3. Serum growth hormone (GH)
4. Serum free fatty acids (FFA) and B- hydroxbutyrate (BOHB)
5. Plasma total and free carnitine
6. Plasma acylcarnitine profile
7. Urinalysis for reducing substances and ketones; consider toxicology
screen
8. Urine acylglycine profile

Any ideas on what these labs are for?
Thanks

The 2hr one...check her sugar two hours after the START of her meal and give her nothing to eat between that time, just the meal. The bedtime one, just check her right before she goes to bed. If she is low, give her a snack with a little carb and some protein. (PB crackers are good). The BMP is just to check her electrolytes (including glucose), blood lactate and pyruvate is to check for lactic acidosis I think, the GH is to check for autoimmune disorder I believe, cortisol is a stress hormone, insulin level is pretty self-explainatory, Ketones is to check her urine for sugar, to see if sugar is spilling over into her urine, which is usually seen with high sugars, total and free carnitine as I understand it, checks for some type of metabolic "error", acylcarnitine (profile) is produced by patients with suspected inborn errors of metabolism and Urine acylglycine profile is an important biochemical tool for the diagnosis of inherited disorders of mitochondrial fatty acid. You should look this stuff up online for further understanding. It sounds like you have a VERY thorough doctor!!! You should be very glad about that...very hard to find! Please keep us posted and I hope everything is ok!

claflamme · 06-22-2008, 07:38 PM

Thank you very much, So far so good she has not had any more low sugar problems,But when she does I will bring her to the lab with the lab slip and bring her 2oz of juice with me to give after. The lab is only a few minutes away,And when she does wake up like that, Thankfully the lab is already opened.
Thank you very much for the info. She does have Celiac Disease also. But It will be tough to try and do the 2hr test since she is a ravenous eater and she is a stick, She is 4 1/2 yrs old and weighs 34 lbs. She eats all day long. That is all she thinks about, Very tough too because with the celiac I run out of ideas what to give her for snacks. I just have to rack my brain so more.
Thank you I will keep you posted though.