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Ketotic Hypoglycemia Toddler

Hypoglycemia In Children

Hypoglycemia In Children

What is hypoglycemia? Hypoglycemia occurs when the blood sugar is too low to fuel the brain and the body. Glucose is the main source of fuel for the body. The normal range of blood sugar, depending on the timing and nutritional content of the last meal consumed, is approximately 70 to 140 mg/dl (milligrams of glucose per deciliter of blood). If you have type 1 diabetes, your goal blood sugar range may be slightly different. Infants and small children with type 1 diabetes will have different goal ranges than adolescents or adults. However, consult your child's doctor for more specific information. Hypoglycemia may be a condition by itself, or may be a complication of diabetes or another disorder. Hypoglycemia is most often seen as a complication of overdoing insulin in a person with diabetes, which is sometimes referred to as an insulin reaction. What causes hypoglycemia? Causes of hypoglycemia in children with diabetes may include the following: Too much medication; for instance, too much insulin or oral diabetes medication Medication mistakes. All families will, at some point, give the wrong kind of insulin for a meal or at bedtime. Inaccurate blood-glucose readings A missed meal A delayed meal Too little food eaten, as compared to the amount of insulin taken More exercise than usual Diarrhea or vomiting Injury, illness, infection, or emotional stress Other medical problems sometimes seen in people with type 1 diabetes, such as celiac disease or an adrenal problem. An additional cause of hypoglycemia in neonates and toddlers includes a group of conditions called hyperinsulinism. This may occur as a result of abnormal cell development of the special "beta" cells in the pancreas that secrete insulin or from a mass in the pancreas. Hypoglycemia due to endogenous insulin i Continue reading >>

First Blog Ever, First Ketotic Hypoglycemic Event Ever...

First Blog Ever, First Ketotic Hypoglycemic Event Ever...

Hi everyone, if there is anyone out there? I am starting up a blog to help provide tips, tricks and advice for those out there who have toddlers with Ketotic Hypoglycemia. My 3 year old son was diagnosed with this condition last weekend. I have yet to find very handy resources for this condition, so I thought it best to start chronicling, not only for myself, but others out there that might find some of this useful. Last Saturday our son woke up quite lethargic, requested and started chugging water (a first), and over a 45 minute period he became virtually unresponsive. His lips were the color of his skin, he was a limp noodle and was sweating profusely. This was all a first. Was he dehydrated? Something was seriously wrong. We could hardly keep him awake. We rushed him to our Doctor's office, luckily right around the corner and open on a Saturday.... Thankfully, the Doc knew immediately to check his blood sugar. His sugar was at a very scary level of 22, and we later learned he was minutes away from seizure! Thankfully, he never had one, or I would have likely had one with him! She was shocked he was even awake (barely). Normal blood sugar levels for a child his age are, ideally, 80 - 150. Most people pass out when they get below 50. The Doc gave him a sugary glucose drink used in diabetic testing, and amazingly he was awake enough to drink it as we would periodically rouse him. His sugars got up high enough for us to transport him to the children's hospital for admission and further testing.... The office Doc first thought it could be diabetes. I immediately began to break down, as I knew what this meant. A lifetime of glucose testing, diet restrictions, hospitalizations... This could not be happening! But none of this would be clarified until days later... We got to Continue reading >>

2017 The Nemours Foundation. All Rights Reserved.

2017 The Nemours Foundation. All Rights Reserved.

No matter what we're doing, even during sleep, our brains depend on glucose to function. Glucose is a sugar that comes from food, and it's also formed and stored inside the body. It's the main source of energy for the body's cells and is carried to them through the bloodstream. When blood glucose levels (also called blood sugar levels) drop too low, it's called hypoglycemia. Very low blood sugar levels can cause severe symptoms that need immediate medical treatment. Blood sugar levels in someone with diabetes are considered low when they fall below the target range. A blood sugar level slightly lower than the target range might not cause symptoms, but repeated low levels could require a change in the treatment plan to help avoid problems. The diabetes health care team will find a child's target blood sugar levels based on things like the child's age, ability to recognize hypoglycemia symptoms, and the goals of the diabetes treatment plan. Low blood sugar levels are fairly common in people with diabetes. A major goal of diabetes care is to keep blood sugar levels from getting or staying too high to prevent both short- and long-term health problems. To do this, people with diabetes may use insulin and/or pills, depending on the type of diabetes they have. These medicines usually help keep blood sugar levels in a healthy range, but in certain situations, might make them drop too low. Hypoglycemia can happen at any time in people taking blood sugar-lowering medicines, but is more likely if someone: skips or delays meals or snacks or doesn't eat as much carbohydrate-containing food as expected when taking the diabetes medicine. This is common in kids who develop an illness (such as a stomach virus) that causes loss of appetite, nausea, or vomiting. takes too much insulin, ta Continue reading >>

Ask The Diabetes Team

Ask The Diabetes Team

Question: From Moraga, California, USA: My daughter was diagnosed with ketotic hypoglycemia at two years, 10 months after a bout of rotavirus. She has consistently been in the 75th percentile for height and 90th percentile for weight, so she does not appear to fit the standard child with ketotic hypoglycemia I have read about. The episode occurred after a trip to a high altitude where she was extremely active (we live at sea level). She started vomiting at 2 a.m. one night during our vacation and could hold nothing down the entire next day, not even a teaspoon of water. We drove home and took her to the Emergency Room (ER) almost 24 hours after the vomiting started. The doctor gave her suppositories to stop the vomiting, but performed no blood work, and we went home. She drank some Pedialyte and juice, about 16 ounces total, through the night and next morning. Around noon, she started vomiting again and could hold nothing down. Mild diarrhea also started. She became more lethargic and that night, around 2 a.m. (48 hours after the vomiting started and 24 hours after the first visit), she started vomiting bile. We took her back to the ER. Her sugar was 26 mg/dl [1.4 mmol/L]. It took a few hours for her sugar to get back over 80 mg/dl [4.4 mmol/L], where they wanted it. She was hospitalized and the doctors performed numerous tests on her, including a fasting blood sugar test, and found nothing out of the ordinary aside from the rotavirus. We saw an endocrinologist who had us test her blood sugar at home for a few weeks. Everything looked okay and we were told she had ketotic hypoglycemia. We just had to be careful to give her something to eat before bed and an early breakfast, which we do. Aside from getting grumpy when hungry, she has been fine since the episode a little Continue reading >>

Hypoglycemia

Hypoglycemia

Hypoglycemia refers to low blood sugar, or technically a lower than normal blood glucose level. It is rarely encountered in pediatric practice outside of the newborn nursery, where it is a commonplace event. Profound hypoglycemia in the newborn can cause brain damage. Aggressive blood glucose monitoring of asymptomatic (nothing appears to be wrong) infants has been the standard. I think attitudes are softening in the era of cost-benefit analysis, since many babies seem to be subjected to large numbers of (in retrospect) needless blood glucose determinations compared to the actual number of significant problems identified. Symptoms of hypoglycemia are generally related to the body's efforts to raise the blood glucose level back to where it should be. These symptoms are really just the manifestations of adrenaline (epinephrine) release, which is the chief signal the body uses to mobilise stored glucose into the bloodstream. The most noticable adrenaline effects are nervousness, light-headedness, increased heart rate, and a particularly urgent sense of hunger. Headache is sometimes a symptom of hypoglycemia; I believe the explanation is brain neuronal cell dysfunction. In the newborn, symptoms of hypoglycemia include sweating, jitteriness, rapid breathing, rapid heart rate, pallor, or even apnea. Profound or very difficult to treat hypoglycemia in a newborn can signal the presence of rare but dangerous conditions such as galactosemia, growth hormone deficiency, insulin secreting tumors, or may reflect severe intrauterine growth restriction (IUGR). Hypoglycemia is the opposite of hyperglycemia - high blood glucose - which is the hallmark of diabetes. True hypoglycemia in children older than newborns is reasonably rare and is not the cause of the myriad complaints and condit Continue reading >>

Approach To Hypoglycemia In Infants And Children

Approach To Hypoglycemia In Infants And Children

INTRODUCTION In healthy individuals, maintenance of a normal plasma glucose concentration depends upon: A normal endocrine system for integrating and modulating substrate mobilization, interconversion, and utilization. Functionally intact enzymes for glycogen synthesis, glycogenolysis, glycolysis, gluconeogenesis, and utilization of other metabolic fuels for oxidation and storage. An adequate supply of endogenous fat, glycogen, and potential gluconeogenic substrates (eg, amino acids, glycerol, and lactate). Adults are capable of maintaining a near-normal plasma glucose concentration, even when fasting for weeks or, in the case of obese subjects, months [1]. In contrast, healthy neonates and young children are unable to maintain normal plasma glucose concentrations after even a short fast (24 to 36 hours) and exhibit a progressive decline in plasma glucose concentration to hypoglycemic values [2,3]. Continue reading >>

Practical Peds: Handling The Hypoglycemic Child

Practical Peds: Handling The Hypoglycemic Child

There are a few kids out there who are prone to hypoglycemia. They may be diabetic and on insulin, or have ketotic hypoglycemia or metabolic disorders that cause them to drop their blood sugars with stress. One thing that mothers can do is stock up on cake frosting. Your next patient is a small five-year-old boy who is rather thin and pale. He is lying on the gurney and not responding to anything. On rapid assessment, his airway, breathing and circulation seem to be OK. He isn’t actively having a seizure. His mom says she brought him in because his blood sugar is low. You get a bedside glucose and she’s right, it’s 38. You start a line and grab a couple of tubes of blood before you start any dextrose. You bolus him with 5 ml/kg of 10% dextrose rapidly through the peripheral line. Now it’s time to talk to the mom and get more of the story. She says he’s had this problem since he was two. He’ll have episodes of vomiting and become unresponsive and when he’s taken in to the ED his blood sugar will be low. He’s been admitted for this in the past but his work-up has been inconclusive. Mom says that she was to tell the ED the next time he came in to get some labs before they give him glucose. OK, now you’re feeling pretty good about those tubes you snagged. This morning was a pretty typical episode for him. He woke up and began vomiting. No fevers. Mom gave him Zofran but he vomited that too. She kept checking his blood sugars and they ranged from 49-59. She made one more attempt to get him to take something by mouth but he threw that up too, so she loaded him in the car and brought him in to the ED. He’s vomited about 8 times. No diarrhea, no fevers, no ill contacts. His past history is otherwise unremarkable. He’s on no meds except Zofran as needed. No Continue reading >>

Non-diabetic Hypoglycemia In Childhood

Non-diabetic Hypoglycemia In Childhood

WHAT YOU NEED TO KNOW: What is non-diabetic hypoglycemia? Non-diabetic hypoglycemia is a condition that causes your child's blood glucose (sugar) level to drop too low. This type of low blood sugar level can happen in children who do not have diabetes. When your child's blood sugar level drops too low, his brain cells and muscles do not have enough energy to work well. Glucose is also important for helping your child's brain grow normally. What causes non-diabetic hypoglycemia in children? The cause of non-diabetic hypoglycemia may be unknown. It may be caused by certain medical conditions. These include hyperinsulinism (your child's body makes too much insulin), hypothyroidism, or prediabetes. It may also be caused by fasting, which can lead to ketotic hypoglycemia. This is a condition that causes the body to change fats into glucose for energy. What are the signs and symptoms of non-diabetic hypoglycemia in children? Hunger or nausea Sweating more than usual Anxiety, confusion, or changes in behavior Fast heartbeat Weakness Blurred vision Dizziness or lightheadedness Headache How is non-diabetic hypoglycemia in children diagnosed? Healthcare providers will ask about your child's symptoms and your family's health. They may ask you about the amount of time between your child's last meal and the start of his symptoms. They may also ask if any other children in your family have hypoglycemia, or have had it in the past. Blood tests are done to measure your child's blood sugar levels. These tests may also be done to find the cause of your child's hypoglycemia. Fasting tests may be done. Healthcare providers watch your child closely during a period of time in which he does not eat. This test is done to see if, and when hypoglycemia occurs. An oral glucose tolerance test may Continue reading >>

Ketotic Hypoglycemia

Ketotic Hypoglycemia

Ketotic hypoglycemia is a medical term used in two ways: (1) broadly, to refer to any circumstance in which low blood glucose is accompanied by ketosis, and (2) in a much more restrictive way to refer to recurrent episodes of hypoglycemic symptoms with ketosis and, often, vomiting, in young children. The first usage refers to a pair of metabolic states (hypoglycemia plus ketosis) that can have many causes, while the second usage refers to a specific "disease" called ketotic hypoglycemia. Hypoglycemia with ketosis: the broad sense[edit] There are hundreds of causes of hypoglycemia. Normally, the defensive, physiological response to a falling blood glucose is reduction of insulin secretion to undetectable levels, and release of glucagon, adrenaline, and other counterregulatory hormones. This shift of hormones initiates glycogenolysis and gluconeogenesis in the liver, and lipolysis in adipose tissue. Lipids are metabolized to triglycerides, in turn to fatty acids, which are transformed in the mitochondria of liver and kidney cells to the ketone bodies— acetoacetate, beta-hydroxybutyrate, and acetone. Ketones can be used by the brain as an alternate fuel when glucose is scarce. A high level of ketones in the blood, ketosis, is thus a normal response to hypoglycemia in healthy people of all ages. The presence or absence of ketosis is therefore an important clue to the cause of hypoglycemia in an individual patient. Absence of ketosis ("nonketotic hypoglycemia") most often indicates excessive insulin as the cause of the hypoglycemia. Less commonly, it may indicate a fatty acid oxidation disorder. Ketotic hypoglycemia in Glycogen storage disease[edit] Some of the subtypes of Glycogen storage disease show ketotic hypoglycemia after fasting periods. Especially Glycogen storage Continue reading >>

[ketotic Hypoglycemia In Children].

[ketotic Hypoglycemia In Children].

Abstract Idiopathic ketotic hypoglycemia is the most frequent cause of hypoglycemia in children between 1 and 5 years of age. The symptoms and signs of hypoglycemia are often overlooked because they mimic signs of other common diseases like psychiatric disorders, migraine, gastro-enterological dysfunction, or visual disturbances. Glycemia and ketone bodies in the urine should be systematically investigated in such cases. Because hypoglycemia is a life-threatening event and can lead to severe neurological sequelae, intravenous administration of glucose is mandatory. These children respond promptly to glucose. Infants with normal growth and psychomotor development, normal physical examination who present with a first episode of symptomatic fasting hypoglycemia and elevated ketonuria, and who improve quickly after intravenous glucose administration, do not need a comprehensive metabolic and endocrine workup. Recurrence of hypoglycemic attacks can be prevented by supplying frequent snacks containing complex carbohydrates, so called "slow sugars", particularly at bed-time. Other causes of ketotic hypoglycemia are briefly presented. Continue reading >>

Missed Meals Or Night Hunger Can Make Your Child Throw Up

Missed Meals Or Night Hunger Can Make Your Child Throw Up

IN MOST cases, we have seen young kids who go to bed or sleep without super and in the night complains of nausea or vomit. When we eat, food, especially carbohydrates, are converted into glucose in the body that provides energy. Glucose in blood is glycemia and in case there is low glucose, then the situation becomes hypoglycemia. The situation whereby kids develop low blood glucose or hypoglycemia and vomit is known as ketotic hypoglycemia. Some parents might not realise that not getting enough food can be the cause of unexplained vomiting for their young ones and this usually happens in the middle of the night or morning. Children who are seemingly health and vomit during the above mentioned times then vomiting is often caused by low blood sugar. However, this problem is often seen amongst children aged nine months and five years. The child will typically feel some nausea or abdominal discomfort just prior to vomiting, and will usually be subdued for about 30 minutes after vomiting, afterwards will otherwise appear normal. Vomiting caused by ketotic hypoglycemia is often misdiagnosed as the stomach flu. The distinguishing feature of ketotic hypoglycemia is that the child quickly returns to normal; if vomiting occurs in the middle of the night, after a short period of general weakness, the child will typically sleep comfortably for the rest of the night. But if vomiting occurs in the morning, the child has to eat before he or she goes for daily activities. Vomits caused by ketotic hypoglycemia differ from those caused by other problems such as the stomach flu. In ketotic hypoglycemia, the Vomitus appears typically bubbly and tinged with a bit of yellow color whereas in stomach flu the vomits are incompletely digested food. Why so common in the middle of the night? Duri Continue reading >>

Ketotic Hypoglycemia In Children

Ketotic Hypoglycemia In Children

Did You Know? Fasting tolerance improves with an increase in body mass, which is believed to be the reason why children with ketotic hypoglycemia outgrow this condition by the time they turn 8 to 9 years old. Ketotic hypoglycemia is the most common type of hypoglycemia that affects children after the neonatal period. However, the condition resolves on its own by the time they reach adolescence. More commonly, children in the age group of 18 months to 5 years experience recurrent episodes of hypoglycemia, especially during an illness or after fasting for a prolonged time period (more than 8 to 16 hours). Hypoglycemia refers to a blood sugar level lower than 70 mg/dL. Usually, hypoglycemia is a complication associated with diabetes. So, diabetic children and adolescents can experience hypoglycemia when they take too much of insulin or eat too little. But, ketotic hypoglycemia has not been found to be related to a specific endocrine or metabolic abnormality. It is mainly associated with low tolerance for fasting, and most children outgrow this condition before they turn 8 to 9 years old. After this age, the incidence of this type of hypoglycemia is quite rare. It is characterized by fasting hypoglycemia and ketosis. Ketosis refers to an increase in the level of ketones in the body. When the level of blood glucose is low, the liver releases its stored glycogen, which is converted to glucose in order to maintain adequate serum glucose. This is then followed by lipolysis, where the fat is broken down by the body to derive energy. The process, however, produces ketones as by-products. So, this condition is where the blood glucose level is low, with elevated levels of ketone bodies. ✦ Ketotic hypoglycemia, also known as 'accelerated starvation', is idiopathic in nature. In ot Continue reading >>

Kids' Hypoglycemia Diet

Kids' Hypoglycemia Diet

A sugar called glucose is a body’s main source of fuel for its many functions. This sugar fuel enters the bloodstream when food breaks down in the digestive system. If your child’s blood sugar levels become abnormally low, he has a condition known as hypoglycemia and he may experience symptoms such as shakiness, headache, sudden behavior changes and confusion, according to the Lucile Packard Children’s Hospital. Adapting your child’s diet may help reduce his risk of seriously low blood sugar levels. Video of the Day Hypoglycemia is a symptom of an underlying condition. Hypoglycemia can occur once in a while, such as if a child overexerts herself without eating enough food for fuel, or it can be a recurrent problem. Although hypoglycemia in children is most often associated with diabetes, many other conditions can cause hypoglycemia. Your child could have a standalone condition called reactive hypoglycemia, where her symptoms occur within about 4 hours of eating a meal. Certain medications, tumors, a hereditary enzyme and hormonal deficiencies can cause hypoglycemia, according to the National Diabetes Information Clearinghouse. Long-term treatment methods for your child’s condition will depend on the underlying problem. For instance, a child with diabetes may not be helped by diet alone; she may also need to take insulin and constantly monitor her blood sugar. Meal Frequency and Size If your child has frequent episodes of hypoglycemia, you may help reduce his blood sugar dips by offering him a nutritious meal or snack every two to three hours, according to the University of Illinois McKinley Health Center. The size of your child’s meals and snacks is also an important part of keeping his blood sugar levels in check. Offering small meals such as a whole sandwi Continue reading >>

Pediatric Hypoglycemia

Pediatric Hypoglycemia

Practice Essentials Hypoglycemia may be considered a biochemical symptom, indicating the presence of an underlying cause. Because glucose is the fundamental energy currency of the cell, disorders that affect its availability or use can cause hypoglycemia. Hypoglycemia is a common clinical problem in neonates, [1] is less common in infants and toddlers, and is rare in older children. It can be caused by various conditions. The most common cause of mild or severe hypoglycemia in childhood is insulin-treated type 1 diabetes, when there is a mismatch among food, exercise, and insulin. (See Etiology and Epidemiology.) Complications Many of the etiologies of hypoglycemia may carry the same consequences, complicating the causal distinction. Infants and children with asymptomatic hypoglycemia have been shown to have neurocognitive defects at the time of hypoglycemia, including impaired auditory and sensory-evoked responses and impaired test performance. (See Prognosis, History, and Physical Examination.) Long-term consequences of hypoglycemia include decreased head size, lowered IQ, and specific regional brain abnormalities observed using magnetic resonance imaging (MRI). Physiologic defenses against hypoglycemia The body normally defends against hypoglycemia by decreasing insulin secretion and increasing glucagon, epinephrine, growth hormone, and cortisol secretion. These hormonal changes combine to increase hepatic glucose output, increase alternative fuel availability, and decrease glucose use (see the diagram below). The increase in hepatic glucose production is initially caused by the breakdown of liver glycogen stores resulting from lower insulin levels and increased glucagon levels. When glycogen stores become depleted and protein breakdown increases because of increased Continue reading >>

Chapter 363: Hypoglycemia

Chapter 363: Hypoglycemia

Any acutely ill child should be evaluated for hypoglycemia, especially when the history reveals diminished oral intake. Diagnosing hypoglycemia promptly is essential because low blood glucose levels that persist or recur may have catastrophic effects on the brain, particularly in infants. Accordingly, the primary care physician must recognize the clinical symptoms associated with hypoglycemia, document the low blood glucose level, and treat appropriately with glucose. Delineating the cause of the hypoglycemia is necessary to initiate effective continuing treatment. A child who has a serum or plasma glucose concentration less than 40 mg/dL or a whole blood glucose concentration less than 35 mg/dL should be investigated and treated for hypoglycemia; those who have plasma glucose concentrations between 40 and 50 mg/dL should be followed carefully.1 On the basis of observational data and expert opinion, the World Health Organization (WHO) currently provides different definitions for different specific clinical categories: newborns and infants with “signs of illness” (<45 mg/dL), healthy term or preterm newborns “feeding well” (<19.8 mg/dL), and infants and children with severe malnutrition (54 mg/dL).2 If hypoglycemia is suspected, then the blood glucose level may be approximated quickly at the bedside using a visual test strip or glucose meter and later confirmed by an appropriate chemical laboratory test. Although these thresholds have been commonly quoted and used, the level of plasma glucose that is safe is uncertain, and some authorities advocate a therapeutic goal of maintaining a plasma glucose level above 60 mg/dL in both neonates and older children to prevent permanent brain damage.3 Continue reading >>

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