Dr. Hive, help me with these test results

[Tiramisu]

High Vitamin B12 (She is a poor eater and does not eat much meat, eggs, etc.)

Low serum glucose 60 (about two hours after eating)

High Immunoglobin A

 

This is for my dd8 who has been nauseous, dizzy, and fatigued this winter.

 

Everything else was in the normal range.

 

Right now she's on allergy meds and zantac and nothing seems to be getting better. The inhaler we used last week did seem to perk her up, though.

[texasmama]

What was the B12 number?  (I know about B12 but not so much about the other stuff.) 

[Tiramisu]

What was the B12 number?  (I know about B12 but not so much about the other stuff.) 

 

B12 is 1177.

 

Thanks for replying. :)

 

I've looked at the Immunoglobin A pediatric ranges and that might be okay given her age, but the glucose is pretty low.

 

I just looked over the results again and it looks like they forgot the mono test. I hate lab mess ups!

[texasmama]

That is a bit high B12, but I don't know of downside to that number.  I have about that due to supplementation via injection.  Low B12 is a problem, but I think high-ish B12 is. 

 

I wonder if the have hit on the right test yet.  Does low blood sugar account for the symptoms?  I know very little about blood sugar.

[Jean in Newcastle]

What did she eat?  If she ate a higher carb meal with low protein, then dropping to 60 might be expected.  60 is the cut off between normal blood sugar in a child and hypoglycemia.  

[Tiramisu]

That is a bit high B12, but I don't know of downside to that number.  I have about that due to supplementation via injection.  Low B12 is a problem, but I think high-ish B12 is. 

 

I wonder if the have hit on the right test yet.  Does low blood sugar account for the symptoms?  I know very little about blood sugar.

 

I think blood sugar could account for the symptoms. I just don't know why her blood sugar would be that low only two hours or so after eating. I would get it if she had been fasting. 

 

The pediatrician hasn't called me; I just got an email from my labcorp account that my results were done. I'd like to hear what the ped has to say about it and if she thinks it's worth following up on. 

 

I don't think this dd wants another blood draw any time soon but I'd appreciate any ideas.

[Tiramisu]

What did she eat?  If she ate a higher carb meal with low protein, then dropping to 60 might be expected.  60 is the cut off between normal blood sugar in a child and hypoglycemia.  

 

I think she had cereal with whole milk. That's her usual.

[Jean in Newcastle]

I think she had cereal with whole milk. That's her usual.

If you are going to go that route, you need a higher fiber whole grain cereal so that the body doesn't metabolize it too soon causing the bloodsugar to go up too high and then crash.  

 

Does she take any multi-vitamins?  (could explain the high vitamin B numbers)

[Jean in Newcastle]

I think she had cereal with whole milk. That's her usual.

If you are going to go that route, you need a higher fiber whole grain cereal so that the body doesn't metabolize it too soon causing the bloodsugar to go up too high and then crash.  

 

Does she take any multi-vitamins?  (could explain the high vitamin B numbers)

[Tiramisu]

If you are going to go that route, you need a higher fiber whole grain cereal so that the body doesn't metabolize it too soon causing the bloodsugar to go up too high and then crash.  

 

Does she take any multi-vitamins?  (could explain the high vitamin B numbers)

 

She only takes children's gummies which don't have a lot of B12.

 

She's a very picky eater and she'll eat Cheerios, but I don't think I can really get her to eat a super healthy cereal. She could have had a reactive hypoglycemic episode, but she shows these symptoms upon waking, too. She does not eat a good dinner EVER. 

[OneStepAtATime]

No specific information for you regarding the test results, Tiramisu, but I am sending hugs.  

 

FWIW, I will add though that as a person who was diagnosed with hypoglycemia as a child (8), I can say that yes, I had dizziness and fatigue.  No nausea that I can recall.  I also had mood swings and although we didn't realize it at the time, I would eat cereal in the morning then my sugar would spike and then plummet rather quickly.  It took a while for the doctors to confirm the diagnosis.  They didn't believe at the time that 8 year olds could have hypoglycemia.  My blood sugar yoyo'd for nearly a year while they kept running tests.  Finally they tentatively agreed that I was hypoglycemic so Mom acted as though I was and changed my diet, etc.  We didn't actually get full confirmation until I was 16 and they ran better tests.  Unfortunately they also dropped my blood sugar way, way too low and didn't give me anything to eat or drink after the tests.  Poor Mom ran into a scary situation while we were trying to head home.  But that's another story.

 

No idea, though, if that is what your child is facing.  I hope you find accurate answers and a way to address whatever it is.  I'm sorry you don't have better answers right now.

 

Best wishes....

 

Edited to add I would usually feel tired, sometimes a bit irrational, certainly not very alert when I would first get up.  I still do if I don't eat some sort of protein in the evening to keep my sugar levels from dropping too low over night.

[dirty ethel rackham]

I have lived with reactive hypoglycemia for the better part of 35 years.  Low blood sugar upon waking is very common in someone with reactive hypoglycemia.  She probably used up all that fuel simply by basal metabolism.  Eating protein/fat with every meal is important as is having balanced carb/protein snacks at regular intervals.  I also get crabby and picky about food when my blood sugar gets too low.  My husband knows that he has to just put something in front of me and order me to eat.  Then, I get more rational.

[mommymilkies]

I have lived with reactive hypoglycemia for the better part of 35 years.  Low blood sugar upon waking is very common in someone with reactive hypoglycemia.  She probably used up all that fuel simply by basal metabolism.  Eating protein/fat with every meal is important as is having balanced carb/protein snacks at regular intervals.  I also get crabby and picky about food when my blood sugar gets too low.  My husband knows that he has to just put something in front of me and order me to eat.  Then, I get more rational.

This!  I am diagnosed reactive hypoglycemic.  New doctors are always skeptical until they call me, frantic, after my blood work.  :lol:   It does the same thing for me. I would strongly recommend watching carb intake and avoiding simple carbs.  The blood sugar crashes have been linked to diabetes later, as well as a myriad of other issues.  She needs to learn to control it and eat a protein heavy and not necessarily low carb, but carb controlled diet.  

[OneStepAtATime]

By the way, Tiramisu, as the wife/mom/daughter of a family of picky eaters, I totally sympathize.  I made a new kind of beef stew last night.  DD at three bites.  DS got nauseous from smelling it and never ate again the whole evening.  DH ate several bits since he had just flown in and was starving but he ended up with a LOT left sitting in his bowl...I ate my bowl full and was happy to have food, but I was the only one.  Very frustrating.

 

If you really do need to change her diet, would she respond to rewards?  Although you have probably tried a ton of different things to help her eat better....To get DS used to the feel of lettuce/kale/cabbage type veggies in his mouth I would put a small portion in front of him (so he wouldn't feel overwhelmed) and give him a nickle for every bite he ate.  He still doesn't like that type of veggie because of the feel but he will eat some now without a big commotion, usually without any complaint at all as long as I don't overwhelm him on portions.  If I had had some nickels lying around and hadn't been so tired, I might have tried bribery with the beef stew...probably would have worked with the kids but I think DH would have held out for more money.  :)

 

[Tiramisu]

By the way, Tiramisu, as the wife/mom/daughter of a family of picky eaters, I totally sympathize.  I made a new kind of beef stew last night.  DD at three bites.  DS got nauseous from smelling it and never ate again the whole evening.  DH ate several bits since he had just flown in and was starving but he ended up with a LOT left sitting in his bowl...I ate my bowl full and was happy to have food, but I was the only one.  Very frustrating.

 

If you really do need to change her diet, would she respond to rewards?  Although you have probably tried a ton of different things to help her eat better....To get DS used to the feel of lettuce/kale/cabbage type veggies in his mouth I would put a small portion in front of him (so he wouldn't feel overwhelmed) and give him a nickle for every bite he ate.  He still doesn't like that type of veggie because of the feel but he will eat some now without a big commotion, usually without any complaint at all as long as I don't overwhelm him on portions.  If I had had some nickels lying around and hadn't been so tired, I might have tried bribery with the beef stew...probably would have worked with the kids but I think DH would have held out for more money.   :)

 

I think the sensory issues are stronger than bribery. :(

 

Food, hair brushing, wearing decent clothes instead of old ripped ones. These are all things that can lead to major meltdowns. Thankfully, she is a generally even tempered or we would have a real problem. I'm counting on puberty and girlie hormones kicking in in a few years and helping to resolve this. She gets along great with people and makes friends wherever she goes, but she doesn't care the least about what other people think.   :banghead:  

 

P.S. I made beef stew the other day, too, and she did eat it. Two days in a row. :)

[Tiramisu]

This!  I am diagnosed reactive hypoglycemic.  New doctors are always skeptical until they call me, frantic, after my blood work.  :lol:   It does the same thing for me. I would strongly recommend watching carb intake and avoiding simple carbs.  The blood sugar crashes have been linked to diabetes later, as well as a myriad of other issues.  She needs to learn to control it and eat a protein heavy and not necessarily low carb, but carb controlled diet.  

 

Protein heavy will be a problem with this one. She will eat meatballs and cheese so I might start there.

 

Last night I let her have cereal before bed. She asked for it when I told her I wanted to eat something before she went to sleep and was incredulous when I actually said yes, as were all the other kids. No cereal outside of breakfast time is a rule around here because a couple of them would eat cereal and nothing else. She woke up feeling better than I've seen in awhile.:)

[sbgrace]

I have a child with reactive hypoglycemia. He would have issues in the morning and about 2 or 2.5 hours post eating. Just a 70 number was enough to cause issues if I am remembering right.

 

My son has issues with textures and eating too. I sympathize.

 

Frequent small meals with protein and fat were key here. Dairy helps us in that regard.

[Tiramisu]

I have a child with reactive hypoglycemia. He would have issues in the morning and about 2 or 2.5 hours post eating. Just a 70 number was enough to cause issues if I am remembering right.

 

My son has issues with textures and eating too. I sympathize.

 

Frequent meals with protein and fat were key here. Dairy helps us in that regard.

 

sbgrace, I was hoping you'd visit since you have some knowledge and experience with metabolic disorders. Something hit me last night: this dd's serum B12 is high. Dd11's serum B12 was high, too, when she was tested a few years ago. Neither are good eaters and taking in the kind of food or supplements that would cause this. I was wondering about a possible metabolic problem that's causing their levels to be high and started googling and found some ideas put forth by Dr. Neubrander who suggests that some kids have high B12 levels because their body lacks an enzyme to get it into the cells where it's needed, so it builds up in the blood. He recommends methyl-B12 shots to address the problem of utilization of B12. This doctor's work focuses on autism. My kids don't have autism but all have sensory issues and B12 levels are connected to proper nerve function, right? This just makes me wonder if this is significant. If it were one kid with high levels, fine. But I have two kids with them. 

[mommymilkies]

I definitely commiserate with the food issues.  My 6 yo is tentatively diagnosed with either sensory issues or infantile anorexia.  Sigh.  ST is helping, though.

[dirty ethel rackham]

Is she getting therapy for the sensory issues?  They really don't go away when they get older, but they do learn to cope mechanisms.  However, these coping mechanisms can be very limiting. 

 

Also, cereal before bed is not a good idea unless it has a very high protein to carb or fat to carb ratio.  Otherwise, you might be inviting very low blood sugar upon waking. 

[Tiramisu]

Is she getting therapy for the sensory issues?  They really don't go away when they get older, but they do learn to cope mechanisms.  However, these coping mechanisms can be very limiting. 

 

Also, cereal before bed is not a good idea unless it has a very high protein to carb or fat to carb ratio.  Otherwise, you might be inviting very low blood sugar upon waking. 

 

I very much agree about the coping mechanisms. I did therapy with dd13 and really did not see any improvement, but our insurance limited the number of visits. When puberty hit, however, we saw a big change. Clothes were always her biggest difficulty and suddenly she wanted to look nice. She also wants to be healthy, so even though she's picky, she makes good choices. Dd8 has the exact same difficulty with clothes (and blood sugar, BTW), so I am hopeful. I have not had the best experiences with the OT place near us that takes our insurance, but I may try them again just to see. Perhaps next year when our schedule will lighten up.

 

I may try cheese and crackers before bed. That would an easy way get some fat into her.

[Laurie4b]

Are you using whole milk on her cereal? You could start gradually adding in some half and half to get more fat into the Cheerios meal. 

What proteins will she eat?

My ds who has sensory issues responded well to practice plus rewards. So choose a food that you would like her to eat and ask her to take 1 bite of it for 9 days in a row. (I think 9 is the magic number. It's been a while.) The mouth gets "used" to the flavor and texture. (Also OT's have some stuff they can do with the mouth for texture issues.)  So if you need a protein, choose one that she's most likely to tolerate and do that for 9 days in a row. I rewarded my son for each bite.  You can explain how the body works, why protein is important and let her select the one she will work on first. Getting her "buy in" is important.

[sbgrace]

sbgrace, I was hoping you'd visit since you have some knowledge and experience with metabolic disorders. Something hit me last night: this dd's serum B12 is high. Dd11's serum B12 was high, too, when she was tested a few years ago. Neither are good eaters and taking in the kind of food or supplements that would cause this. I was wondering about a possible metabolic problem that's causing their levels to be high and started googling and found some ideas put forth by Dr. Neubrander who suggests that some kids have high B12 levels because their body lacks an enzyme to get it into the cells where it's needed, so it builds up in the blood. He recommends methyl-B12 shots to address the problem of utilization of B12. This doctor's work focuses on autism. My kids don't have autism but all have sensory issues and B12 levels are connected to proper nerve function, right? This just makes me wonder if this is significant. If it were one kid with high levels, fine. But I have two kids with them. 

 

I don't know! There can certainly be malabsorption of b12, particularly when stomach acid is low or digestion is compromised for other reasons. My son struggles with malabsorption. His blood levels of various things, though, are low as a result. I don't know if b12 might work differently. I found this, indicating that possibly poor conversion of folate and b12 can result in high blood levels http://www.gapeysgrub.com/2013/03/methylation-mthfr-cbs-genetics.html That mutation is very common in the general population. So I think this might be something for you to explore.

 

 

When I read your OP, I wondered if she might be getting supplemental b12 in foods like her breakfast cereal. If she's eating a lot of that sort of thing, it's possible she's taking in more than you think. But it's also possible she's not using it.

[Tiramisu]

I don't know! There can certainly be malabsorption of b12, particularly when stomach acid is low or digestion is compromised for other reasons. My son struggles with malabsorption. His blood levels of various things, though, are low as a result. I don't know if b12 might work differently. I found this, indicating that possibly poor conversion of folate and b12 can result in high blood levels http://www.gapeysgrub.com/2013/03/methylation-mthfr-cbs-genetics.html That mutation is very common in the general population. So I think this might be something for you to explore.

 

 

When I read your OP, I wondered if she might be getting supplemental b12 in foods like her breakfast cereal. If she's eating a lot of that sort of thing, it's possible she's taking in more than you think. But it's also possible she's not using it.

 

I haven't been back here to thank you....so thank you. It was a busy weekend but I did get to fit in a little reading from you link and the places it took me. It is very interesting and helped me find a possible cause of my scary sulfite sensitivity.