Suspect 11yo hypoglycemic - what are best tests for him?

[lazydog]

Hi.  Son has been unwell for a while now with nausea, stomach pains, cold sweats, low temps (35.1 to 36.5), feeling cold on hot days, fatigue.  These things come and go.  Had bad time early 2006 but tests showed nothing now has been full on for 3/4 weeks.  Family history of Hashimoto's, SLE - so am suspecting autoimmune disease...  10 days ago I discovered his coldness would go if he ate a barley-sugar!  I have a pathology request for random glucose test but wondering if I should do it on empty stomach.  Don't want to waste a test!
Yesterday out shopping he got cranky waiting for me and he went ahead to buy lunch.  Found him at the sandwich shop ordering extra large chicken schnizel and salad s/wich with ham!!  (which he never normally eats.)  He ate the lot.  He is slim btw, and doesn't eat much junk food.  Takes a salad roll and an apple to school for lunch.  Now and then he gets very hungry but wondered if he just growing...now not so sure.  He seems to be worse in the mornings...very cold and feeling sick.  He used to be always hot and I'd be telling him to put a jumper on.
Does this sound like pre-diabetes?  Can he stay hypoglycemic for years?  What tests should I have done for diabetes/hypoglycemia so he can get help before he's clinical?
Thanks for any help.
...J

[JDRF-VOL-SG]

His symptoms do sound suspiciously like hypoglycemia. All of the things you mentioned are symptoms that can appear when glucose is low.

The test that we recommend in the United States to check for hypoglycemia is a glucose tolerance test. I suspect from some of the foods you are listing that you do not live in the United States, so I don't know what this test would be called in your country. But you can describe it to his doctor: the test works by comparing results of one blood test done when the person is fasting (no, don't feed him before the lab draws his blood) and then having the person drink a sugary syrup that normally should cause glucose levels to rise. They test again a few hours after he drinks this to see how his body reacted. This will show hypoglycemia IF his hypoglycemia is caused when the body is over-stimulated to produce insulin. Some hypoglycemic people test as normal with this test, though.

Another test you can ask to have done is to test for antibodies that show if the body's immune system is attacking the pancreas to eventually cause diabetes. If these antibodies are present, then he should be watched closely in coming years, The antibodies don't necessarily mean a person will become diabetic, but they will be present if he is in the process of becoming a type 1 diabetic.

If both tests come back as normal, then all you can do is to try to change his diet -- dietary changes sometimes help people who have problems with hypoglycemia. By the way, many people live with hypoglycemia and NEVER become diabetic at all. The website www.hypoglycemia.org will have some good information on it that might help.

[lazydog]

Hi.  Your comment of some people who are hypoglycemic never develop diabetes is encouraging.  I will check out the website you mentioned.  What is the antibody test you mention - I would like to have that test done, and as you say, watch for any change.  I know with Hashimoto's and SLE the antibodies are the key.  
I only have a request for a single glucose test.  Is that worth doing I wonder or should I go and ask for the other glucose tolerance test.
There has always been something not quite right with my boy.  He would fatigue easily and he was a one-activity-per-day kid.  He also got hives often.  His stamina seems to have improved as he gets older, but now these other things are showing themselves.  He seemed to be sick more often than other kids but these past weeks he is constantly sick.  We are in Oz btw.
Thanks for your info.
...J

[JDRF-VOL-SG]

Just ask your doctor to check for islet-cell antibodies. I am not aware of any technical term for the test other than this.

The one-time glucose test will show what your son's levels are on that particular day at that particular time, and may or may not show if he is hypoglycemic (it depends on where his levels are at the time of the lab work). But a one-time test WILL show if his glucose levels are high enough to be diabetic, for a true diabetic person's levels are going to be high no matter when the test is done.

The benefit to a glucose tolerance test is that it shows what the body does in response to stimulus to the pancreas. Again, some people test normally -- it just depends on what that person's body does on that particular day at that particular time in reaction to drinking the sugary syrup. This test shows more accurate responses if the person seems to react strongly to eating sweet foods -- called reactive hypoglycemia. If the hypoglycemia is not triggered by eating high-glycemic index foods, it may very well come back normal. But again, it WILL show up any diabetic tendencies.

[lazydog]

Thanks so much for that info.  That's exactly what I've been wanting to know.  I've been googling for days and not found the info you've just given me.
I will go ahead with the one-time glucose test firstly and if no answers I will ask for the glucose tolerance test....and lastly the antibody test.  Thanks so much for the info.  It would be nice to get to the bottom of what the problem is, so my boy can off-load the nausea and fatigue etc.
...J

[kls1972]

. i am a diabetic and have been for 13 years now i found out i was one when i was 9 years old. i used to be a really big kid and then i just rapidly started losing weight even though i was eating more than i used to. I also would wake up during the middle of the night and get a tea picture (gallon size) and fill it with water and drink it until i made myself vomit. I could not control my thirst and now everyonce in a while when my blood sugar level rises i get really tired and sleepy like i cant hold my eyes open i get very ill and my whole body hurts like the flu or something for about a day until i get all of the sugars out of my blood system. i  really study up on this stuff because i start school in January and i am going into endocrinology..because of all the visits i have had to go through to one. it would be a good ide to take your son to an endocrinologist because it could also be thyroid problems and the endocrinologist can check all glads.