Ketotic hypoglycemia is when the body has low blood sugar (hypoglycemia) and high blood ketones. The liver makes ketones when it doesn't have enough insulin. A person who doesn't eat or drink for long periods will develop ketotic (kee-TAH-tik) hypoglycemia. In kids, this can happen when they have vomiting or diarrhea. To keep your child safe, your health care team prescribed a blood sugar meter so you can measure your child's glucose when needed.

Ketotic hypoglycemia can happen more quickly in some children, such as those who don't eat enough, are sick, or are thin. Ketotic hypoglycemia most often happens first thing in the morning after a child has not eaten all night.

• When your child is vomiting or has trouble eating due to a sickness, try to get them to take small sips of a drink with sugar in it a few times an hour. Drinks like breast milk, formula, juice, regular soda, Gatorade®, or Pedialyte® can help keep their blood sugar normal.
• It is important to follow your health care provider's instructions on how often to check your child's blood sugar with the blood sugar meter.
• If your child has a low blood sugar, repeat the test right away to confirm. Then, follow your health care provider's instructions to raise the blood sugar.
• To prevent ketotic hypoglycemia:
  • Give your child a bedtime snack every night and something to eat first thing in the morning.
  • Don't let your child go too long without eating. Follow instructions from your health care provider about how long it is safe for your child to fast overnight.

• Your child's blood sugar is low even after you treat it.
• You have any questions about your child's care.

• still has low blood sugar after you called your health care provider and treated it as recommended
• is confused, very tired, or unresponsive

• Your child has a seizure or passes out.

Why is low blood sugar a problem? Sugar (glucose) is the body's main source of fuel. If the body does not have enough sugar, it cannot work normally. Having low blood sugar for too long can cause seizures and brain damage. It is very important to treat low blood sugar right away.

What are the symptoms of low blood sugar? Symptoms of low blood sugar (hypoglycemia) include headache, vomiting, sweating, shaking, confusion, drowsiness, hunger, fast heart rate, and dizziness. If the blood sugar is very low, children also can pass out or have a seizure.

Could there be another reason my child has ketotic hypoglycemia? A few rare genetic disorders can cause ketotic hypoglycemia. Your child's health care provider will know if your child has signs of a disorder and will decide if genetic testing is needed. Most children with ketotic hypoglycemia do not need genetic testing.