Conversation: The conversation between human and AI assistant.
[|Human|] My grandaughter is 10yrs old, pale colouring and slightly built. Ever since she has been about 4yrs old she has suffered from lethargy and lately have noticed slight tremor in hands when she starts to get hungry before regular meals. After eating she is fine again for about 4hrs.
[|AI|]  Hello, Read your concernThere are many causes for which your granddaughter may have these symptoms. Please get her blood sugar level checked to rule out diabetes which may cause such symptoms. Also, such symptoms may be seen in a condition known as insulin which is a tumor of the beta cells of the pancreas. This tumor is characterized by Whipple s triad where signs and symptoms of hypoglycemia are seen with blood glucose levels lower than 45 mg/DL. The characteristic feature is improvement of the symptoms on administration of glucose. This leads me to advice you to get the blood glucose, insulin and c-peptide levels tested. These will help us to rule out other conditions of hypoglycemia as well. A proinsulin level is also advice, if possible. Diagnostic imaging test would include USG, CT scan or an MRI to trace the tumor, if any. It will be appreciated if you could provide more details about her symptoms at the time of tremor. As for e.g.: does she get cold and clammy, irritated, anxious, does she sweat a lot etc. These will be of help too. Hope you get back with the Blood reports. Take care. Hope this helps. Chat Doctor.