Low Blood Sugar and Seizures in Teenagers: A Case Study

Q: Low Blood Sugar and Seizures in Teenagers: A Case Study

Dear Mr. Zhang： 1. There are many causes of hypoglycemia; among them, iatrogenic hypoglycemia is the most common, primarily caused by oral hypoglycemic agents or insulin. If this is not the case, a thorough consideration of other factors is necessary. Generally

High school student with hypoglycemic coma?

Hello Doctor, my daughter, who is in her first year of high school, suddenly reported feeling dizzy and weak while studying at home in mid-December.
I intended to check her blood pressure (her school health check and regular measurements show she often has low blood pressure, with systolic readings around 90 and a heart rate in the 70s).
However, within a minute, she lost consciousness and became completely limp.
I quickly called an ambulance.
By the time the ambulance arrived, she had regained consciousness and was responsive but unable to walk due to weakness.
She was unconscious for about three minutes (when I asked her later if she heard anything while unconscious, she said she had no awareness at all).

In the ambulance, her oxygen saturation was normal, and her systolic blood pressure was over 110, but her blood sugar was only 51 (it had been 3.5 hours since dinner, and she had been eating normally).
They promptly administered a glucose IV and an injection of high-concentration glucose.
After rechecking her blood sugar, it was around 240, and her mental state improved significantly, with less overall weakness (she experienced involuntary shaking, which subsided about half an hour after arriving at the hospital).

At the emergency department, blood and urine tests were conducted, all of which returned normal results with no signs of infection.
They monitored her blood sugar every hour for a total of three times (after the second measurement, they stopped the glucose IV and allowed her to eat some food).
After the third measurement showed normal levels, she was discharged with instructions to monitor for any pre-syncope symptoms and to carry candy for emergencies.
Three days later, during a follow-up at the pediatric clinic, the doctor ordered blood tests and an EEG.
The blood tests were normal, but the EEG showed abnormal discharges while she was awake.
The doctor suggested that her loss of consciousness was due to epilepsy.
However, her blood sugar was 51 at the time of the incident, and she gradually recovered after receiving glucose.
The doctor mentioned that epileptic seizures typically involve full-body convulsions and stiffness, and patients usually feel fatigued and want to sleep after regaining consciousness.
In contrast, my daughter became increasingly alert and felt well after receiving glucose, although she did experience a headache.

The doctor stated that symptoms of hypoglycemic coma include cold sweats and hunger prior to the episode, and that patients can hear sounds while unconscious (my daughter did not experience these symptoms).
Therefore, the doctor concluded that her loss of consciousness was unrelated to hypoglycemia and was caused by epilepsy.
The day before the clinic visit, my daughter had experienced mild dizziness and weakness about 40 minutes after breakfast, which lasted for about 20 minutes without improvement until she quickly consumed a sugary drink and candy, after which her symptoms gradually alleviated.

This has never happened to her before, and she has never sustained any injuries.
I would greatly appreciate your guidance.
Thank you!

Mr. Zhang, 40~49 year old female. Ask Date: 2018/02/02

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Zhang:
1.
There are many causes of hypoglycemia; among them, iatrogenic hypoglycemia is the most common, primarily caused by oral hypoglycemic agents or insulin.
If this is not the case, a thorough consideration of other factors is necessary.
Generally, hypoglycemia can be classified into fasting hypoglycemia and reactive hypoglycemia.
The former typically occurs 4 to 5 hours after eating and often indicates underlying health issues.
Possible conditions include insulinoma, liver dysfunction, alcoholic hypoglycemia, septic infections, anterior pituitary insufficiency, adrenal insufficiency, hypothyroidism, tumors, kidney disease, excessive exercise, severe malnutrition, and insulin-related autoimmune diseases, among others.
The latter usually occurs within 2 to 4 hours after eating and is often due to functional disorders or early diabetes; it may involve postprandial hyperinsulinemia, functional hypoglycemia in early diabetes, or endocrine insufficiencies, etc.
2.
The seizures and subsequent fatigue you mentioned regarding epilepsy refer to the common generalized tonic-clonic seizures; however, there are also many types of absence seizures that can sometimes be difficult to detect or recognize.
3.
The situation regarding your daughter is somewhat complex, and it is difficult to make a judgment without further information.
If the symptoms persist, it is advisable to seek the joint assistance of a neurologist and an endocrinologist, as they may provide a more convincing diagnosis.

Reply Date: 2018/02/02

More Info

Low blood sugar, or hypoglycemia, can be a concerning issue, especially in teenagers who are still growing and developing. Your daughter's experience of sudden dizziness, weakness, and loss of consciousness is alarming and warrants a thorough understanding of the underlying causes and preventive measures.

Hypoglycemia occurs when blood glucose levels drop below normal, typically below 70 mg/dL. In your daughter's case, her blood sugar was recorded at 51 mg/dL, which is significantly low and can lead to severe symptoms, including confusion, weakness, and even loss of consciousness. The symptoms can vary from person to person, and not everyone will experience the classic signs of sweating or hunger before a hypoglycemic episode. Some individuals may not have any warning signs at all, which can make it particularly dangerous.

Several factors can contribute to hypoglycemia in teenagers. These include:
1. Dietary Factors: Skipping meals, not eating enough carbohydrates, or consuming a diet low in calories can lead to low blood sugar levels. Even if your daughter had eaten dinner, the timing and composition of her meals could have played a role, especially if she was studying and possibly not eating snacks during her study session.

2. Physical Activity: Increased physical activity, especially without adequate food intake, can deplete glycogen stores and lead to hypoglycemia. If your daughter was studying late into the night, she may have been more sedentary, but if she had engaged in any physical activity earlier in the day, it could have contributed to her low blood sugar.

3. Hormonal Changes: Adolescents experience significant hormonal fluctuations that can affect insulin sensitivity and glucose metabolism. Stress, whether from school or other sources, can also impact blood sugar levels.

4. Medical Conditions: While diabetes is a common cause of hypoglycemia, it is not the only one. Other conditions, such as adrenal insufficiency or certain hormonal imbalances, can lead to low blood sugar. Since your daughter experienced a seizure-like episode, it is essential to consider whether there might be an underlying condition that needs to be addressed.

5. Medications: If your daughter is taking any medications, even those not typically associated with diabetes, they could potentially influence her blood sugar levels.

Regarding the seizure-like episode, it is crucial to differentiate between hypoglycemia-induced seizures and those caused by epilepsy or other neurological conditions. The fact that her blood sugar levels were low at the time of her episode suggests that hypoglycemia could have played a role. However, the subsequent EEG findings indicating abnormal electrical activity in the brain may suggest a separate issue, such as epilepsy. It is not uncommon for hypoglycemia to mimic seizure activity, but the absence of typical seizure symptoms (like generalized shaking) and the rapid recovery after glucose administration could indicate that the hypoglycemia was a significant factor.

To prevent future episodes, consider the following strategies:
- Regular Meals and Snacks: Ensure your daughter eats regular meals and includes healthy snacks throughout the day, particularly if she is studying or engaging in physical activity. Foods that combine carbohydrates with protein or healthy fats can help maintain stable blood sugar levels.

- Monitor Blood Sugar: If she has experienced low blood sugar episodes, it may be beneficial to monitor her blood sugar levels regularly, especially during times of stress or increased activity.

- Educate on Symptoms: Teach her to recognize early signs of low blood sugar, even if they differ from the typical symptoms. Encourage her to carry a source of quick sugar, such as glucose tablets or candy, at all times.

- Follow-Up with Healthcare Providers: Since her case involves both hypoglycemia and abnormal EEG findings, it is essential to maintain regular follow-up appointments with her healthcare providers. They may recommend further testing or monitoring to ensure her safety and well-being.

In conclusion, while hypoglycemia can be dangerous, understanding its causes and implementing preventive measures can help manage the risk. It is essential to work closely with healthcare professionals to monitor her condition and ensure she receives appropriate care.

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