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Ketotic Hypoglycaemia
Posted on Jun 24, 2016
Ketotic hypoglycaemia is the most common type of hypoglycaemia 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 hypoglycaemia, especially during an illness or after fasting for a prolonged time period (more than 8 to 16 hours).

Hypoglycaemia refers to a blood sugar level lower than 70 mg/dL. Usually, hypoglycaemia is a complication associated with diabetes. So, diabetic children and adolescents can experience hypoglycaemia when they take too much of insulin or eat too little. But, ketotic hypoglycaemia 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 hypoglycaemia is quite rare.

What are the causes of ketotic hypoglycaemia?

Ketotic hypoglycaemia, also known as 'accelerated starvation', is idiopathic in nature. In other words, its causes are not known with certainty. Basically, children with this condition have a low tolerance for fasting.
  • One possible cause is a defect in gluconeogenesis, or generation of glucose from non-carbohydrate sources that mainly takes place in the liver. Another suspected cause is inadequate glycogen stores.
  • Ketotic hypoglycaemia is more common in children born small for their gestational age, and those who have a low body mass index. Therefore, it is thought that reduced muscle mass could be the reason behind impaired glucose production or gluconeogenesis by the liver, that eventually leads to hypoglycaemia.
  • It has been observed that children born small for their gestational age, who develop transient neonatal hyperinsulinemic hypoglycaemia, can later on develop ketotic hypoglycaemia as well. Transient neonatal hyperinsulinemic hypoglycaemia is characterised by an excessive production of insulin, and so it is suspected that a metabolic or endocrine problem may be associated with the problem in some patients.
  • It has been observed that certain factors can trigger an episode of hypoglycaemia. Some such important precipitating factors include fasting for a prolonged period skipping dinner and eating too little, or low carbohydrate intake the previous night illnesses like a viral infection or stomach flu.
Episodes of ketotic hypoglycaemia mostly occur in the mornings, usually after a prolonged period of fasting. Some of the most common symptoms that this condition can produce are:

How ketotic hypoglycaemia is diagnosed?

This condition is diagnosed with the help of a number of tests and examinations that help rule out the possibility of other conditions that can also cause hypoglycaemia with ketosis. Tests are carried out for measuring the levels of insulin, the growth hormone, cortisol, and lactic acid.

If the episodes of hypoglycaemia are quite frequent, then the patient is closely monitored during a diagnostic fast. This test helps find out how soon the glucose levels begin to fall following fasting, and whether the metabolic responses to falling glucose levels are normal.
The best way to prevent ketotic hypoglycaemia is to avoid extended fasts and the habit of skipping a meal. Children with this condition should be fed small, but frequent meals and snacks, especially before going to bed. After the usual duration of sleep, they should be awakened and fed properly.

During an episode of hypoglycaemia, you should immediately feed the child a source of easily-absorbed glucose, such as table sugar, candies, or fruit juice. If hypoglycaemia causes vomiting, then the child should be admitted to the hospital, where the condition can be treated with the intravenous administration of saline and dextrose.

Diet should include healthy and nutritious foods. Foods with high fibre content, such as fruits, vegetables, and whole grains, should be incorporated in their diet. Such type of food can ensure the release of glucose at a slow and even pace, and thus, help maintain the level of blood glucose. If a hypoglycaemic child has a low body mass index, then along with nutritious foods, the physician may prescribe some nutritional supplements as well.
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