What is and isn’t hypoglycemia in children

The Pediatric Insider

© 2013 Roy Benaroch, MD

There’s a common “health entity” thing, often called “hypoglycemia.” Funny thing about that—children who have it are not hypoglycemic. But it is a real thing nonetheless, and there are steps parents can take to help deal with it.

Confused?

First: hypoglycemia means low blood sugar, and it can occur. In pediatrics we see it in tiny newborns and very sick children, or in little toddlers sometimes; it’s also seen in children with diabetes who get too much insulin. The main symptoms of hypoglycemia, real hypoglycemia, with real low blood sugars, are sweatiness, disorientation, unconsciousness, coma, and seizures. Real hypoglycemia is a big deal. Let’s call it HYPOGLYCEMIA, in all caps.

But what’s commonly called hypoglycemia in other situations isn’t really hypoglycemia. Here we mean a child (or adult) who gets cranky or headachy or irritable or just doesn’t feel right, especially several hours after a meal. If you check their blood sugars during an episode, it is normal. Their sugars are not low. Nonetheless, they feel better after a snack, especially a carb-snack with a jolt of tasty sugar. So they seem to be suffering from symptoms of hypoglycemia, even though they don’t have HYPOGLYCEMIA.

What’s going on here?

The symptoms of the lower-case hypoglycemia are real. They may not be caused by actual low blood sugar, but perhaps by a fall in the relative level of sugar from normal to lower-normal. Alternatively, it may be that other fuel sources in the blood (maybe an amino acid named alanine) have falled, though we don’t usually test for that.

So what should doctors and parents do when they have a child with the symptoms of HYPOGLYCEMIA—seizures and coma? Test sugar, and test everything else!

For the symptoms of hypoglycemia, no testing is needed. It’s going to be normal. Instead, families can learn to manage this problem on their own. The main therapy is to prevent these episodes of symptoms by providing frequent, healthy snacks—especially snacks that combine carbohydrate with fat or protein.

A quick biochemistry lesson: all carbs (including simple sugars and starches) provide a quick jolt of sugar, rapidly providing metabolic energy. But it may not be sustained—sugars are metabolized quickly. To provide sustained elevations in metabolic fuel, carb-rich snacks should be combined with foods rich in fat or protein, which are broken down slower.

A can of Coke, alone—that’s a terrible snack. As would be a glass of orange juice, or an apple. All of these are 100% carb. But smear that apple with peanut butter, or dunk carrot sticks in ranch dressing—those are snacks that will provide lasting food energy.

This kind of hypoglycemia (lower case) is sometimes referred to as “reactive hypoglycemia”, a term that’s just as misleading and even more abstruse. It tends to run in families, and in my experience affects skinny, active kids. If that sounds like your child, you don’t need a bunch of tests. You just need healthier snacking habits. Easy as pie… a la mode!

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