Toddler develops hypoglycaemia when off colour

[LizzyA123]

Hi,

my little boy has had 3 episodes of severe hypoglycaemia since October 2008, requiring hospitalisation and much prodding, poking, stabbing and distress. The first time he was comatose in his cot after being a little off colour, the 2nd time he had a slight upset tummy beforehand and the 3rd time (last week) he had chicken pox, and was being continually sick. He had a hypo' just after birth but no reason was found for that.

Has anyone any experience of repeated hypo' episodes in non-diabetic infants?

How do you know he's not diabetic? because he's showing all the signs pof classic diabetes!

These aren't symptoms of diabetes..i'm diabetic and i do go hypo but that's cos of the insulin i take

If he had diabetes he'd be v thirsty and v tired, is he showin any of these symptoms Lizzy?

Tis unuasual! Wot did they say at the hospital?

DD had suspected hypos around the age of 2. Not as serious as your DS - more delirious, distressed and floppy. We were supposed to be keeping a diary for GP (and were) but she seems to have grown out of them. We try to make sure she doesn't get low blood sugar (lots of food regularly, food before naps etc.).

(I have a lot of experience of such things, although not diabetic myself.)

Sorry - that's not really any help medically.

How old is your DS?

BTW - DD is not a diabetic, nor is she now showing signs.

Not diabetes - that is the opposite, you only get hypos because of the treatment.

Presume he is having further investigations? Sounds like something metabolic. Given they have all been associated with intercurrent illness there is a condition called MCADD whic can present like this although it is now part of the newborn screening test.

Basically he needs further investigation and given he was admitted previously I would be very surprised if it hadn't already been arranged.

Yes, both my brothers and my sister used to have regular (well, irregular but frequent) hypoglycaemic episodes (I was the only one of us who didn't). One of my brothers grew out of it by the time he got to 5 or 6; my other brother and my sister still had occasional episodes into their teens. They all grew out of it by adulthood.

And we got the insistence from friends and acquaintances that they must be diabetic if they were having hypo episodes, too. And every time my brother had an episode at school they'd make him eat a huge plateful of chocolate .

Hi again,

My DS is 26 months old now and his newborn MCADD test was fine. Diabetes, as many of you have said, has been ruled out. DS was born with trigger thumbs which are sorting themselves out now but he failed to gain weight properly until about 6 months old and on solids; I think i must have been producing skimmed breast milk . He had a basic genetic screening, in SCBU, which showed him to be a normal male. Last week DS had some tests at the hospital which were mostly normal although there was a mention of borderline liver enzymes and slight metabolic acidosis. He is being refered to a metabolic expert soonish.

In the meantime, does anyone has any tips on how to keep his blood sugar level up when he is vomiting to avoid the need for an IV and hospital. I have hypostop gel, a blood glucose monitor and some glucose powder to mix in his drinks.

Does anyone know how to get him to keep something down long enough for the glucose to be absorbed?

Sorry to hear about your DS, when my DD2 is hypo (she's 3 now) and has a vomitting bug we give her ice lollies to suck or small sips of Ribena. We have also offered jelly babies. Full sugar jelly is good too. Sometimes we succeed, sometimes we don't. Its hard when they are little, DD has ended up on a drip twice now due to not being able to keep her bloods up.

What are his bloods like at night? We find milk at bedtime great for keeping levels steady overnight, the fat content apparently.

LR x

My mother used to give my siblings glucose sweets. Just sucked and allowed to dissolve in the mouth they generally would get some glucose into them without triggering more vomiting.

Yes we use glucotabs for normal hypo's (ie ones brought on by too much insulin or lots of exercise). They can be quite chalky for little ones though....jelly beans work well.

My siblings, Dc, and I have hypoglycaemia. When had illnesses as children my mother would always give us a glass of cola and a packet of crisps regularly - she realised that sometimes the hypo was due to low salt levels too. We were never hospitalised with it as children, although one brother and I have fallen unconscious with it as adults. I take similar precautions with my children. Along with regular meals and snacks (all hell breaks loose if I forget the snacks - my DC are unable to regulate their behaviour when their blood sugar levels drop!) They too have a particular difficulty with illness.

This is the first I have heard of needing tests/investigation. My GP advised that I continue as I am for the DC and myself. You will learn to spot the warning signs and know how to deal with it as you go along. Perhaps it helps that I too have it, so I know from experience what is going to make the children feel better or not.

My GP warned me against glucose tablets.

Foods that I have found to help:

• Satsumas/tangerines or something similar (also good to fit in handbag)
• Orange juice drinks
• nuts and seeds (sesame snack bars are v good)
• cup of tea (with a spoon of sugar if in need)
• I try not to use cola and crisps for obvious reasons
• regular supply of hobnobs/digestive biscuits
• always serve puddings (cake and custard/rice pudding/etc)

Why did he/she warn you, GreenGables?

Hi Lulurose - great idea with the ice lollies, I'll try that.

Gave him full sugar ribena and banana milkshakes after his drip was removed and he had stopped vomiting because he didn't want to eat for another 24 hrs, this seemed to help his blood sugar levels.

Usually he is fine overnight, but if he has gone to bed on an empty stomach for any reason, I have become paranoid. I wake him up in the middle of the night to have a sugary drink just in case. At least that way I can get some sleep without worrying about what I might find in the morning. I just hope his teeth don't suffer as a result.

GreenGables - I think the tests are being arranged because my DS has a couple of minor physical issues, he only started walking 4 weeks ago, has an "innocent" heart murmur and trigger thumbs so I guess the Drs want to make sure that there aren't any underlying conditions that need treating.

Glad to hear that you and yours are coping with your hypo's. How do you stop your kids from crashing when they are vomiting?

Has he been tested for Addisons?

Yes, I worry about DDs teeth too but so far so good, if you do have to give sugary drinks in the night use a straw and then it tends to not pool in the mouth so much. My DD sips lucazade or fruit juice without even waking up properly now .

My DS is 4.5 and has just been in hospital for a metabolic fast. He does has SN of an, as yet, undiagnosed genetic disorder.

He produces ketones rather quickly and was one comatose after only vomiting 4 times in 24 hours.

We have been put onto 'emergency regime' for when he is poorly/stopped eating which is 20% carbs.

On the info it states that Lucozade Energy Original (not fruit) is 20% but we have to add Maxijul to cola, fruit juice, full sugar squash ribena ready to drink and five alive (blackcurrant only).

Innocent smoothies are around 20% carbs too, look at labels to see how much carb per 100ml to work it out.

TBH we use innocent smoothies as a way of regulating him, so he gets one mid morning/afternoon to keep him going between meals. Because he likes them, he is less suspicious of being offered them when off colour.

Also agree with full fat milk at bedtime, if he misses this he wakes with 'pear drop breath' (ketosis).

Should just say, my own experience of hypoglycaemia is because my DD2 has Type One Diabetes so it is a bit different...she drops low for reasons usually related to me over estimating the carb content of her meals and therefore giving a little too much insulin. When she has tummy upsets we have lots of lows too.

Since she started on her insulin pump though she is has much better and I no longer have to feed her between meals which she used to hate.

Great tips musnetters - I will try them out and see how we get on.

Hi smudgethepuppydog - I've not heard of Addisons I'll look it up.DS has had some tests and further investigations are being arranged.

On the one hand I am glad that the Drs are being thorough, on the other I still wonder if all the testing and referals for are a bit overboard and if just a decent management regime when DS has a tummy bug is all that is required.

MarmadukeScarlet - My son develops eggy breath rather than pear drops when ill and off food. Not sure if that is because his tummy is upset or because he is low.

Anyway - I will try all the tips and let you know how I get on

MarmadukeScarlet - I forgot to say that DS has also been prescribed maxijul, I mix it in his juice too when he is off his food. My DS had a controlled metabolic fast test in November, the Drs couldn't get the canula (for blood sampling) in easily and he was distressed, crying and sweaty I felt like a traitor letting them do it but needs must. Is your DS going to have further tests?.

Gums have a very good blood supply. If he is vomitting and can't keep fluids down, try rubbing jam into his gums. It absorbs into the blood stream rapidly.

Again, hypostop gel rubs into the gums nicely.

Lizzy, when DS is off his food sometimes I have to empty a juice carton, mix it in and put it back in the carton using a funnel in the straw hole or he is suss and will not drink! Canny little sausage.

When DS had his fast they put the cannula in about 6pm, bloods done then and again at 7pm when he had his bedtime milk. Urine samples taken all night with the little stick on bags (his poor bits were so red with all the sticking and peeling, poor chap) Then bloods done twice in night, and hourly from 8am, half hourly from 10am until 12miday.

Blood sugar went fairly low, ketones in urine from 9am. Fasts are not too dreadful for him as he is not at all food motivated.

Am still waiting for appt with metabolic consultant.

I'm sorry you had such trouble with the cannula, it is so distressing. DS has had so many tests etc I am now really hot on how the staff approach it. I ensure emla cream is put on and I time the full 60 minutes, I also get them to freeze spray it too.

The position they sit in is v important also, at my local hosp pead ward they make him sit facing me so I can hold him, but this makes him 'fight' to get free - last time they did this was when he was almost unconscious from not eating/vomiting and he still put up such a fight that me, SHO, REG and 2 nurses could barely hold him he got so sweaty and slick. The last fight was enough to make him loose consciousness and just go completely limp mid struggle .

At The Evelina they sit on your lap facing away from you, you cross one of your legs over theirs (if the are tall enough) and you hug them with both arms holding one of their arms to theri body and the nurse gently supports the cannulating one. He has never even cried at any of the Evelina blood tests/cannulations.

Although they didn't stick it or bandage it properly, so we did have to have it faffed around with quite a bit but luckily he was a very brave boy and it remained patent.

MarmadukeScarlet,

It's amazing where they get the strength to stuggle from when low.

The Drs made my DS sit facing me too so I could hug him but he did fight me. My DH had to help hold his legs still and the SHO, REG and 2 nurses had to keep wiping him down because he was so sweaty that they kept losing their grip and the tape wouldn't stick. I have to say that it was much easier for everyone the first time because he was comatose and knew nothing about it (not suggesting that as a solution mind. Does that cream actually work my DS had it on about an hour before the procedure but still kicked off, I didn't know if it was pain or distress or both.

Lizzy,

It must do as DS really never makes a peep nowadays but you should hear him if they try and put a bp cuff on him!

TBH if they are hooking them up as an emergency to get gluocose drip in I get them to freeze spray him, but for routine stuff we go for Emla.

I get it from the GP and put it on myself, with the special patches. I also bandage them to stop him pulling the patches off! Then you are all ready when you get to your appointment, so no waiting around working selves (DC and Mums ) up into state.

DS has tests quite a bit and this works for us everytime, as does play therapist if she is there.

WE now go to London (20 min drive, 50 mins train, 20 min walk) rather than local hospital (15 min drive) because it is so much better there. Also DS loves going on the train for a treat!

Good luck with your next test/set of results.