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Toddler with hypoglycemic episodes ... risk of juvenile diabetes??
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Toddler with hypoglycemic episodes ... risk of juvenile diabetes??

My almost three year old son has had two hypoglycemic episodes in the last two months ...  One on 12/23 and one yesterday morning, both of which landed us in the ER ... The first time - in December - he had a pretty severe experience; he was virtually unconscious, and his blood sugar (glucose? forgive me, I'm still trying to keep the lingo straight) was 18 ...  He spent the night in the hospital and was released the following day, having maintained 'normal' glucose levels both with/without an I.V. ... At that time, his pediatrician felt as though he wasn't at risk for diabetes, or even further episodes ... In that physician's experience, he had had other patients around the same age that had had the same kinds of episodes, all without further trouble.  This morning, I think I may have caught him just in time ... He was difficult to wake and very agitated, lethargic, etc., so I tested his urine (it tested positive for moderate amounts of ketones, negative for glucose), made him drink a couple of ounces of cranberry juice, and under his doctor's advice, took him back to the ER ... His blood and urine tests there returned normal, and we were able to come home in just a couple of hours ...

After that rather long-winded summary, I'm sure you can guess my questions and concerns ... Is my son at risk for juvenile diabetes?  If not, what is the difference between this sort of 'ketonic hypoglycemia' and type I or type II diabetes?  In any case, what should our next steps be?

Thanks so much, in advance, for your time, experience and expertise.  We look forward to your input.
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Are you a nurse? (I am, too)

It is absolutely abnormal, frightening, and extremely unusual for a previously healthy 3 year old to have hypoglycemic episodes of the magnitudes you describe.

You are lucky you found him before he died or suffered brain damage.  Hypoglycemia of the severity you describe can lead to all kinds of terrible sequelae.  

Move it, NOW.  Find a pediatric endocrinologist immediately.  I am shocked and appalled that your pediatrician would not have sought consultation and comprehensive evaluation by now.  

Post back with what you discover.  Good luck.
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So sorry to read about your frightening episodes.  It is great that you're so tuned into your toddler's behaviors to have been able to catch & treat a low very quickly.

There is some evidence that hypoglycemia can preceed Type 1 diabetes, but it is not always the case.  I'm not a physician, and in your shoes, I'd begin scouring my area for a pediatric endocrinologist or other pediatrician who can help you learn learn learn and treat whatever comes up.

Either a diagnosis of hypoglycemia or diabetes can feel devastating and there are challenges to manage either one.  Nonetheless, many of us long-timers lead full, rich lives and you can expect that for your toddler, too.
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Samsmom,

I volunteer for The Juvenile Diabetes Research Foundation and am a mom of a 16 year old who has had diabetes since the age of 21 months.  The information that is given is my opinion based on my own personal experience.  I am not a medical professional and information received in this response should be verified with your healthcare team.  

I emphatically agree with the other two responses that you have received on your posting.  This is a serious condition that needs to be treated by a specialist (endocrinologist) immediately.  Your pediatrician is not a specialist.  You cannot continue guessing what is happening with him, so please call your local children's hospital NOW and get your son examined.  

Please let us know how you make out and how is is doing.

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I totally agree with the folks who have written to encourage you to find a specialist ASAP. I don't know whether you are aware of what normal glucose readings are... normal is considered to be any reading between 70 and 126. A reading of 18 is much lower than your average hypogclycemic episode for people who tend to be hypoglycemic, for most people start to feel bad immediately when glucose drops below 70 (I am a type 1 diabetic, but can assure you that I can feel somewhat "off" when glucose even is at the 70 level, and even though I have suffered severe hypoglycemia from insulin overdose at times, a reading of 18 has been almost unheard of). I would definitely NOT consider this normal and would not simply wait to see what happens. I do know that parents of young diabetic children are told by endocrinologists not to let blood sugars drop too low because of danger of brain damage to young developing brains. Do insist on seeing an endocrinologists. Something has caused these episodes and finding a cause and treating it is imperative to your child's development.
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your child sounds more like he has a metabolic problem...a glucose level of 18 is dangerous...i would have him seen at a childrens hospital nearby and i wouldnt leave until they gave me an answer....some things that it could be is a liver strorage problem, some type of metabolic disease, some type of ingestion problem causing a poisoning of some type.....this is not normal and needs to be addressed immmediately.....good luck
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I have had a somewhat similar experience with my then 15 month old son.  One morning my son was hard to wake and very lethargic...after bringing him downstairs in the morning I knew something was wrong.  All of a sudden he collapsed and became unresponsive(just as you described. We rushed him to the ER by ambulance.Blood sugar was not taken immediatley, but when it was it was in the 40 range. The pediatrician thinks this may have been elevated due to adrenaline.  He too spent the night and blood sugars remained normal with and without IV.  Of importance...my son did have 1 mild episode of diaherra (diarrhea) the day before.  His appetite has not the greatest, but he was hydrated, etc.  I have suspected one other simialr problem after he was being very physical.  Orange juice was given and he seemed fine.  After consulting with pediatrician and specialist they have provided me with a "presumptive diagnosis" of ketonic hypolglycemia.  Stating that when there are symptoms of severe lethargy, usually after increased physical activity or post fasting (more than 10 hours or so)to take him to ER for a series of blood labs.   The only treatment for this sort of condition is frequent meals and snacks that contain sugar, carbohydrates and proteins - we provide a bedtime snack of yogurt, chocalte milk, etc. I also have the glucose monitor if I suspect a problem. I've been told that it is better to assume that this may be what he has, but you can't be sure unless the correct lab work is done while child is in this state.  Also, all of his other tests done by specialst ruled out any other medical problems.  Hope this helps somewhat. If you want more details of my experience with specialist, etc. let me know.
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My 22 month old son just went through the exact same thing this last weekend.  He was listless, limp, and non responsive.  He did not flinch or make a sound when the nurses put in the cathiter or the IV.  His blood sugar was 30 when he arrived at the ER.  It was extreamly frightening.  Our pediatritian has given us several pieces of info and advise which may be helpful.  If your child has had a very busy day or is coming down sick at all, give him something to eat and drink in the night to help sustain his sugar throughout the night.  This is a disease that shows up usually between 18 months to 3 years old and usually goes away between 8 to 10 years old.  It is twice as common in boys as it is girls.  Also, definatly set up an appt with a pediatric endrocronogist immediatly.  Our pediatrician has already set up an appt for us with the endrocronologist and a pediatiric dietician.  They will help to determine that there are not other factors causing this and how to handle and hopefully help prevent any future problems.
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Avatar_n_tn
My 22 month old son just went through the exact same thing this last weekend.  He was listless, limp, and non responsive.  He did not flinch or make a sound when the nurses put in the cathiter or the IV.  His blood sugar was 30 when he arrived at the ER.  It was extreamly frightening.  Our pediatritian has given us several pieces of info and advise which may be helpful.  If your child has had a very busy day or is coming down sick at all, give him something to eat and drink in the night to help sustain his sugar throughout the night.  This is a disease that shows up usually between 18 months to 3 years old and usually goes away between 8 to 10 years old.  It is twice as common in boys as it is girls.  Also, definatly set up an appt with a pediatric endrocronogist immediatly.  Our pediatrician has already set up an appt for us with the endrocronologist and a pediatiric dietician.  They will help to determine that there are not other factors causing this and how to handle and hopefully help prevent any future problems.
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Avatar_n_tn
My 22 month old son just went through the exact same thing this last weekend.  He was listless, limp, and non responsive.  He did not flinch or make a sound when the nurses put in the cathiter or the IV.  His blood sugar was 30 when he arrived at the ER.  It was extreamly frightening.  Our pediatritian has given us several pieces of info and advise which may be helpful.  If your child has had a very busy day or is coming down sick at all, give him something to eat and drink in the night to help sustain his sugar throughout the night.  This is a disease that shows up usually between 18 months to 3 years old and usually goes away between 8 to 10 years old.  It is twice as common in boys as it is girls.  Also, definatly set up an appt with a pediatric endrocronogist immediatly.  Our pediatrician has already set up an appt for us with the endrocronologist and a pediatiric dietician.  They will help to determine that there are not other factors causing this and how to handle and hopefully help prevent any future problems.
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