Blood sugar issues?

[ncoombsy]

My now 6-year-old son has been having episodes upon waking in the morning, which were happening about twice a year, but have increased in frequency to once every one to two months. He is lethargic, extremely weak (explained by him as having no power), and is very pale. Every time this happens, he will not wake on his own. Nearly every time, something sugary with recover him quickly, although sometimes he will vomit before we can even make it to the kitchen. He is confused and talks out of context sometimes, or his words are unorganized. For example, this morning, I made him rest on the sofa after the episode, while I put on a show on the TV. I asked him if he wanted some water, and he said, "Yes, I can use it while the movie." Note the word "use" instead of drink or have some, and not a complete sentence. Although was language delayed previously, his language skills are up to par to date. Also, last episode, 10/4/12, my husband and I gave him cake icing to recover quickly, while we were "joking" with him saying, "That's silly, Connor. You're eating cake icing for breakfast," to keep the mood light for him, although we were scared for him. Later, Connor did not recall anything.

We eat very healthy, I have to say. My son was at risk for autism, having SPD, social and language delays, unusual play with wheels/cars, and other issues that were typical for disorders on the spectrum, and since then, we have a very clean diet. I looked back on that evaluation report from his developmental pediatrician when he was 4yrs, 4mths old, and at that point, he had had 4 of these episodes since the age of >2yrs. While under her care, he had two episodes.

Since that report, these episodes are becoming more and more frequent. His last three episodes were 9/8/12, 10/4/12, and this morning, 12/26/12, where before, the episodes were only happening once or twice a year.

His latest developmental pediatrician diagnosed him with ADHD last year, however, thinking he was not on the spectrum. She wanted to rule out seizures first, and so we had a 3-day ambulatory EEG, which was totally negative.

His regular pediatricians have gotten blood work for glucose levels and whatnot, and everything seems to come out fine.

Do these episodes sound like blood sugar "crashes" in your opinion? Also, I have always been curious if these episodes (but on a lesser level throughout the day) have anything to do with what might look like ADHD? Could it all be related somehow? BTW, he is not on any medication. He does take omega-3 and evening primrose (omega-6). Any thoughts would be appreciated.

[ncoombsy]

He has only been evaluated by two developmental pediatricians, not a neuro-D-P. The first developmental pediatrician did a neurodevelopmental evaluation, however. Here is the result of that:

NEURODEVELOPMENTAL EVALUATION

Neuromaturation:  Connor is ambidextrous and has trouble crossing midline; laterality is established on himself with crossing on both upper and lower body but not onto examiner.    Gait and station: Walk and run – well, reciprocal, some toe-gait; good arm swing.  Skip – not able to do even with demonstration.  One-leg stance: 1-2 seconds with flailing.  Standing broad jump (3 year level skill): initially not coordinated but fairly neat on 3rd attempt.  Tandem: Forward – not able to do.  Romberg: Attained well, some finger twitching. Finger apposition/sequence: Accurate initially with slow processing to transfer visual to motor configuration; unable to complete.  Oromotor overflow: Present with these and fine motor tasks.

Observations:  Connor came with his mother and in the waiting room greeted me with “Are you the doctor?”  He was at that point sitting in a chair separate from his mother.  Then and for the first ½ hour of the time in the office, he had great intensity about his actions, eye contact and verbalizations.  He was immediately interested in the toys and completed the shape sorter ball matching.  Hand use was a bit clumsy to awkward; actions big and definite energy.  Throughout he tended to interact not only verbally but physically, ie. coming quite close or sitting on a lap or hugging.  He generally responded to holding or acupressure (sterno-clavicular and back thoracic, facilitating lymphatic drainage due to his congestion) with calming. For a bit he spoke to the adults through a puppet and answering questions about himself through the puppet; also used it to hand something to examiner.  For a short period he perseverated on saying “I want colored Goldfish!”  That did not transition to further verbalization about being hungry or other food choices when his mother said she did not have them with her.  Most of the time his verbalizations were well articulated, complete sentences with good inflection.   At one point while looking at a book with a title on the cover, he jargoned as if “reading” the title.  Most of the time he alerted readily to his name.  He did calm and participated well in testing, eager to do his best.  If a verbal direction was given but a high-interest visual stimulus occurred, the visual took precedence.  A few times when given a verbal direction with eye contact, he initially stared blankly and if allowed time, finally responded with the answer or action.  Overall he was eagerly, spontaneously social with intensity; but reciprocal verbal interaction was less expressive than non-verbal.  There were no repetitive, stereotypic, self-stimulatory behaviors observed.  

Testing [4 yrs 4 mos]: Gesell Figures:  Connor named circle, square, triangle and diamond; sometimes initially responding “I don’t know” and then answering either correctly or incorrectly but with one of the group of shape names.  He chose to draw with the large bore crayon but tended to use an overhand fist grasp.  He was able with hand-over-hand assistance to switch to his “pencil grasp”.  The circle was drawn slowly, steady lines but with consistency and confidence (3 yr task level).  The lines of the cross (4 yr task level) met nicely in the middle were fainter, wavier lines.  Connor needed to switch hands to cross midline for the horizontal.  He carefully studied both square (4½ yr task level) and triangle (5 yr task level) and nearly completed both drawing large figures with wavier lines.  Age-equivalency: 5 year level in visual perception; 3 yr level in motor coordination and planning.   Draw-a-Person Test:  Connor spontaneously and repetitively drew smiley faces as part of drawing circles.  He resisted/avoided drawing in response to a verbal request.  Score: 3-4; age-equivalency 3¼ -3 ½ years.  Gesell Block Skills:  Connor enjoyed the reward of completing a 10 block tower (3 yr task level).  When faced with more challenging tasks, he often reverted to that more comfortable task level. He completed the 3 block bridge and after a couple of differing patterns of approach the double bridge (4 yr task level). He was unable to imitate the 4 block bridge (6 yr task level) but recognized the stair configuration.   Hands steady, no tremor but awkward use.   Academic screening: Reading: Connor reads all upper and lower case alphabet letters but not 2-3 letter words.  Denver II: Connor’s performance in the 4 skill domains was as follows.  Personal-social: Age-appropriate, but limited test tasks for this age.  Fine motor-adaptive: Borderline.  See Gesell figures above.  Language: Suspect.  Connor enjoyed these tasks and his times of prompt success in spite of the challenges.  He mis-heard 1-2 words so the responses were based on mis-information (ie. What is a desk? Based on his answer “boat”, he likely heard the word “deck”).  Occasionally he took a long time to answer, staring blankly, with a quiet look on his face indicating he was thinking and working to get the answer.  He also used non-verbal responses, eg. eyes flicking to the named object in the room or pointing to it (eg. What is a ceiling? He replied “not get wet” and then pointed up to the room ceiling). On the easier tasks, he also supplied a word associated with one word in the question rather than responding to the meaning as a whole, eg. What do you do when you are cold? He replied with a brief action like a shiver to a blank look on his face.  In contrast to these difficulties he performed average for age on naming opposites.  This task requires one word responses and meaning is more visual.   Gross motor: Suspect due to balance.

Dr. Anitha, my son gets plenty of sleep, 11 hours most nights, and he gets plenty of daily exercise. Does this sound like it could be something else? I remember him getting a lot of blood work done, and one resulted in low carnitine. However, it was only slightly low, and from what I've read, biological differences only happen if it is in the 10-20% range. It was not that low.

[Paderla Anitha, DNB]

Hello and hope you are doing well.

Has he been evaluated by a neurodevelopmental pediatrician? If the developmental evaluation is normal and if the tests done are within normal limits, you need not worry. It could just be that he needs more sleep. Ensure to see he gets adequate sleep and also he should exercise or play well, this promotes an overall well being. In the initial phases of the sleep cycle and while awakening, we tend to be more conscious or alert. And this twilight phase could cause some confusion.

Hope this helped and do keep us posted.