Hyperinsulinism -
Most cases present during the 1^st year of life as a result of familial or non-familial nesidioblastosis or islet cell dysmaturity syndrome. Islet cell adenoma usually present as hypoglycemia in a child 5 years or older.

The hallmark of hyperinsulin states is the inability to withstand fasting.
Patients have ravenous appetites, increased demand for food and weight gain. Jitteriness and seizures are common. At the time of documented hypoglycemia, ketonemia is low or absent. There is no acidosis and S. insulin levels are usually higher than 5 to 10 mcg/ml with elevated C-peptide (In factitious hypoglycemia, due to exogenous administration of insulin, C-peptide is not elevated). Also S. insulin levels may be more than 100mcg/ml). Hyperinsulinism is confirmed by fasting for several hours under close supervision and collecting blood samples for testing. MRI or high-resolution ultrasonography may be helpful in locating a pancreatic adenoma. Surgery is the treatment of choice.

Ketotic hypoglycemia -
It is the most common cause of childhood hypoglycemia. It usually presents between the age of 18 months and 5 years and remits spontaneously by 8 to 9 years of age. Hypoglycemia usually occurs during illness when food intake is limited. Diagnosis is confirmed by fasting for several hours under close supervision and collecting blood samples for testing. At the time of hypoglycemia, there is associated ketonemia & ketonuria. S.alanine levels are reduced. Treatment consists of frequent feedings of a high-protein, high carbohydrate diet. During periods of illness, parents should check the child's urine for presence of ketones, as it appears several hours before hypoglycemia. If urine ketones are positive, liquids with high carbohydrate content should be given to the child.