What is Ketotic Hypoglycemia?

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What is Ketotic Hypoglycemia? - diabetic testing suppliesWhat is Ketotic Hypoglycemia?

Imagine waking to find your 2-year-old child shaking and sweating. She starts vomiting and refusing to eat. Sounds pretty scary and yet some parents are all too familiar with this scene.

This scenario plays out frequently and the parents know they need to get sugar-rich drinks into their child immediately in order to avoid convulsions and unconsciousness. They try energy gel applications on the child’s chin and ultimately resort to an intramuscular injection of Glucagon.

Finally, the child improves but it takes several hours before they resume eating and drinking normally again.

If I came across this scene with my grandson I would understand his blood sugars were dangerously low.

I know this because he has been diagnosed with type 1 diabetes melitus.

As a family, we have spent the last year and a half learning about diabetes and how to best care for Alex.

In the scenario described above, that child is not diabetic and just randomly has these hypoglycemic episodes.

This condition actually seems to have three names but they all refer to the same condition:

  • Ketotic Hypoglycemia
  • Idiopathic Ketotic Hypoglycemia
  • Idiopathic Ketotic Hypoglycemia of Childhood

What causes Ketotic Hypoglycemia?

Contrary to what I believed, Ketotic hypoglycemia (KH) is the most common cause of hypoglycemia presenting to Emergency Departments in healthy children between 6 months and 6 years of age.

Ketotic hypoglycemia is usually triggered by a lack of food due to illness with vomiting or prolonged fasting due to nausea.

It could also be triggered by a period of fasting (usually overnight) following a period of increased exercise.

I believe that Ketotic hypoglycemia reports to the emergency room more frequently than diabetic hypoglycemia because the diabetic and their caregivers are taught that low blood sugars can and will happen and they are also taught how to treat thus avoiding a trip to the emergency room.

How is Ketotic hypoglycemia diagnosed?

What is Ketotic Hypoglycemia? - blood tests

In most cases, parents discover alarming symptoms and take the child to the Emergency Room. Here doctors order these diagnostic tests:

  • insulin levels
  • growth hormone
  • cortisol levels
  • lactic acid

Doctors will need to know these levels at the time of hypoglycemia.

Other tests such as plasma acylcarnitine levels and urine organic acids will help doctors exclude some important metabolic diseases.

The biggest factor in diagnosing Ketotic hypoglycemia is in eliminating other causes of hypoglycemia.


How do you prevent Ketotic hypoglycemia?

Children diagnosed with ketotic hypoglycemia often grow out of it by the 3rd or 4th grade, unlike their diabetic counterparts.

Ketotic hypoglycemia is treated very similarly to diabetic hypoglycemia.

The parents are advised that the child should avoid fasting.

The child has a bedtime snack usually consisting of a combination of carbohydrates and protein.

If they are vomiting or refusing to eat, you should wake them in the night and offer snacks or fluids containing glucose such as fruit juice.

When our grandson’s blood sugar levels drop too low during the night we find that giving him a few sips of apple juice is usually all he needs to get his blood sugars to start rising to within his target range.


How do I know if my child is hypoglycemic?

If you experience any of these symptoms, you may have low blood sugar:

  • extreme hunger (kids often complain of a gnawing stomach or hunger pain)
  • shakiness or tremors
  • rapid heart rate
  • cold sweat
  • pale grey skin colour
  • headache
  • moodiness (crankiness, irritability)
  • drowsiness

Is Hypoglycemia a sign of diabetes?

Hypoglycemia is not a sign of diabetes but is often experienced as a result of diabetes.

Diabetes is usually diagnosed when blood sugars are too high(hyperglycemia).

Low blood sugars can occur by taking too much insulin, not eating enough(prolonged fasting) or exercising more than usual.

As I explain in this article, sometimes people can experience hypoglycemia when they are not diabetic.

How do I treat hypoglycemia?

If you recognize any of the symptoms of hypoglycemia you should:

Eat 15 – 20 grams of a fast-acting sugar carbohydrate snack.

What is Ketotic Hypoglycemia? - fast acting sugar snacks or fruit juice

This would be food with little to no protein or fat that can easily be converted into sugar in the body. Some suggestions of food to try would include:

  • glucose tablets or gel
  • fruit juice
  • regular (not diet) soft drink
  • honey
  • sugary candy

Retest blood glucose levels after 15 minutes.

If your blood sugar levels are still too low, eat another 15 grams of fast-acting carb snack.

Recheck again after 15 minutes.

Continue repeating these steps until blood sugar levels begin to rise and are near normal or target range.

Have a snack or a meal.

Once your blood sugar levels have returned to normal you should have a proper meal or snack to help replenish your body’s glycogen stores.

This can help stabilize you so you don’t fall back into another hypoglycemic event.

Does low blood sugar mean ketosis?

Low blood sugar does not mean ketosis.

Ketosis is a state where the body burns fat for fuel rather than sugars from carbs. This state is often sought by people following the popular Ketogenic diet for weight loss.

Don’t confuse this with the very dangerous diabetic ketoacidosis which is a serious and potentially deadly complication of diabetes.

In my article entitled What is Ketosis and Ketoacidosis, I clearly explain the difference between the two.

Can hypoglycemia lead to ketoacidosis?

Hypoglycemia is a condition where the blood sugar levels are too low.

Diabetics and their caregivers are all too familiar with low blood sugars.

In most cases, hypoglycemia develops because diabetics have taken too much insulin or medication to reduce high blood sugar and their levels subsequently dropped too low causing hypoglycemia.

Ketoacidosis is not a result of low blood sugar, it is actually the result of blood sugars remaining too high for too long a period.

When a child develops low blood sugar as a result of Ketotic Hypoglycemia, there is no medication involved.

In fact, the incident of hypoglycemia may seem random and without explanation.

Final Thoughts

What is Ketotic Hypoglycemia?

Quite frankly, learning that non-diabetic kids could experience low blood sugars seemingly at random scared me.

Seriously though, as one of our grandson’s caregivers, I understand what hypoglycemia is and what to do to treat it.

I understand when I should call 911 (or the equivalent emergency number for your area) and when I can treat him myself.

If your child is not diabetic you haven’t been taught what to do if hypoglycemia occurs.

That can be a scary thing and I hope this article helps you better understand what to do while boosting your confidence that you can successfully treat low blood sugar.

It has always been my goal to help educate people on things diabetes-related.

I understand that Ketotic Hypoglycemia does not have anything to do with diabetes with the exception of low blood sugars and how to treat them.

If your child experiences Ketotic hypoglycemia be sure to work with your doctor to determine the best treatment for your case.

I am not in any way a medical practitioner, please do not rely on the information on our website as an alternative to medical advice from your doctor or another healthcare provider. We only share our experiences.

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6 thoughts on “What is Ketotic Hypoglycemia?”

  1. I had never heard of Ketotic Hypoglycemia before but I know what it is now. You did a thorough and comprehensive explanation of it in this post as well as how to prevent, diagnose, and treat it. I never realized that if a child avoids food or goes without it for an extended period of time could trigger it. Thanks for sharing this informative post.

    • Hi Justin, thanks for dropping by and taking the time to comment. As a grandparent of a type 1 diabetic, I was aware of diabetic hypoglycemia but like you, I was unaware of the fact that non-diabetic children also experience hypoglycemic events. I find that when researching all things diabetes-related, I tend to follow every rabbit hole and stumble upon the most interesting knowledge. I love learning new things and subsequently pass on that knowledge. I am grateful you were able to learn something. Education only helps us better care for those we care about whether adult or child. Thanks again and take care.

  2. What a scary thing for any parent or grandparent to have to experience! I know that I would freak out big time! My dad has diabetes so I’m familiar with the highs and lows that come with that as well as the impact that diet plays when it comes to blood sugar levels. However I had no idea that non-diabetic children could experience such low blood sugar levels like you’ve described. That’s certainly something to take careful note of!

    • Thanks for dropping by Lynne, yes it would be scary to witness in a non-diabetic child. We all experience low blood glucose levels from time to time which is where the term “Hangry” comes from. Low blood sugars can cause us to feel cranky, irritable, light-headed and these symptoms subside shortly after eating. Just keep an eye on the kids and if they seem off, a little snack may be all they need to be back to normal.

  3. Hi Deb, this is the first time I have gained so much information about Ketotic Hypoglycemia. I know it does exist but had no idea that children can suffer from this disease. I remember that my grandmother was a diabetic, but it was one of the mild forms I guess as she didn’t even need insulin. All she needed was a good diet and some medication. What have you described above is a completely different story and I have learned a lot about the treatment and signs.

    • Thanks for dropping by Olabee, and taking the time to comment. I am so glad you were able to learn something from my article. It sounds to me like your grandmother likely had type 2 diabetes which is controlled by diet, exercise and oral medications. Only rarely, in the most severe cases do they require insulin. Ketotic Hypoglycemia is quite scary because the person is NOT a diabetic and therefore not expecting a hypoglycemic event and are not trained on what to do. That is why I felt the need to get this information out there. So if someone recognizes these symptoms they will know what to do. Thanks again and take care.


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