From Silver Spring, Maryland, USA:
My 20 year old son was seen by an internist today for low sugar levels. He has not been diagnosed with diabetes or hypoglycemia yet. He was ill (he is on an antibiotic and other medications) and because of some of his symptoms, it was suggested that I take a fasting blood sugar test on him (I had gestational diabetes). It was 127 mg/dl [6.7 mmol/L]. This reading was the day before he started his medications. That evening, after showing him how to monitor himself each morning, 90 minutes after a large dinner, he was at 44 mg/dl [2.4 mmol/L] and shaking, sick to his stomach and light headed. I immediately gave him a soda, and it came up to 113 mg/dl [6.3 mmol/L] at 15 minutes. At half an hour, it had dropped to 111 mg/dl [6.2 mmol/L] then to 95 mg/dl [5.3 mmol/L] at one hour. By morning, he was 57 mg/dl [3.2 mmol/L], and, after a large dinner that night was so low the monitor couldn't detect it. I tested myself to determine if there was a problem with the monitor. I was normal. His blood was so thin and pale, I was worried about anemia.
Would you get an error in the reading if the person is anemic, since it is reading the sugar in red blood cells? This morning, he was at 52 mg/dl [2.9 mmol/L].
Several people have told me this may be the beginning of diabetes, yet I have read in some of your letters that you don't feel that is true. Since he is sick and on medication, the doctor wants to wait until he is healthy to do blood work. She has ordered fasting glucose plasma and a HbA1c in two weeks and has put him on a hypoglycemia diet until then. He has told me that he hasn't felt well in a long time. He lifts weights and halfway through, he would get shaky. So he seems to have been symptomatic for a while.
I do not think that the blood sugar patterns which you describe in your son are due to anemia nor to a technical error. They rather suggest a condition which is called reactive or
(after a meal) hypoglycemia, which is due to an inappropriately delayed surge of insulin after ingesting carbohydrate. Because the one fasting blood sugar was marginally into the diabetic range, I think that this is quite possibly the diagnosis. Another fasting blood sugar will help to confirm this, but the HbA1c may be normal because any periods of glucose intolerance may have been compensated by the hypoglycemia. Under these circumstances, it would be worth discussing the possibility of an antibody test with your son's doctor. If it is positive, it would confirm the diagnosis of type 1A (autoimmune) diabetes.
Diabetes is not the only basis for this phenomenon, however, because others (such as alcohol ingestion, glucagon insufficiency, and malnutrition) may sometimes be involved.
I do not think that your gestational diabetes or the medications that he is taking have any role.
Original posting 1 Nov 2000
Posted to Diagnosis and Symptoms
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