How should I manage a 15‑year‑old adolescent who has intestinal helminths in his stool and a glucose of 56 mg/dL—should I treat the parasites, confirm whether the glucose was obtained after an overnight fast, evaluate for hypoglycemia symptoms, advise on regular meals and balanced snacks, and arrange appropriate follow‑up?

Management of a 15-Year-Old with Intestinal Helminths and Glucose of 56 mg/dL

Treat the intestinal parasites with a single 400 mg dose of albendazole immediately, confirm whether the glucose was drawn fasting, assess for hypoglycemia symptoms, and if symptomatic or if the glucose was non-fasting, initiate further evaluation for pathologic hypoglycemia.

Immediate Hypoglycemia Assessment and Management

Confirm Fasting Status

• Determine whether the glucose of 56 mg/dL was obtained after an overnight fast or in the fed state. A glucose of 56 mg/dL in a fasting adolescent may represent normal variation at the lower end of physiologic range, whereas the same value in the non-fasting state suggests pathologic hypoglycemia requiring investigation 1, 2.

Symptom Evaluation

• Assess for hypoglycemia symptoms including dizziness, sweating, shakiness, confusion, headache, pallor, palpitations, tremors, aggressiveness, drowsiness, or behavior changes 3, 1.
• If the patient is symptomatic with glucose ≤70 mg/dL, administer 15–20 g of fast-acting oral glucose (glucose tablets or solution preferred) immediately, recheck glucose in 15 minutes, and repeat treatment if hypoglycemia persists 1, 2, 4.
• After glucose normalizes, provide a meal or snack containing complex carbohydrates and protein to prevent recurrence 1, 4.

Decision Algorithm for Further Evaluation

• If the glucose was non-fasting OR if symptomatic hypoglycemia occurred, arrange urgent endocrinology evaluation to exclude insulinoma, adrenal insufficiency, or other pathologic causes 1, 2.
• If the glucose was fasting and the patient is asymptomatic, counsel on regular meal timing with balanced snacks containing protein and complex carbohydrates every 3–4 hours, and avoid prolonged fasting periods 3, 2.
• Instruct the patient to always carry glucose tablets or fast-acting carbohydrate sources 1, 2.

Parasitic Infection Treatment

Albendazole Dosing

• Administer albendazole 400 mg as a single oral dose with a fatty meal (approximately 40 grams of fat) to enhance absorption by up to 5-fold 5, 6.
• This single-dose regimen achieves cure rates of 91.9% for Ascaris lumbricoides, 87.2% for Ancylostoma duodenale, and 78% overall for hookworm species 6, 7.
• For Trichuris trichiura (if identified), a triple-dose regimen (400 mg daily for 3 consecutive days) is warranted to achieve adequate cure rates of approximately 48–71% 8, 7.
• For Taenia species (if identified), administer 400 mg daily for 3 consecutive days to achieve 100% cure rates 8, 7.

Mechanism and Safety

• Albendazole inhibits glucose uptake by parasites through microtubular destruction, depleting glycogen stores and ATP production, ultimately causing parasite death 5, 9.
• The drug is remarkably safe with gastrointestinal side effects occurring in only 1% of patients in clinical trials involving several hundred million exposures 7.
• Monitor complete blood count and liver enzymes every 2 weeks during treatment due to potential bone marrow or hepatic toxicity 5.

Follow-Up for Parasitic Infection

• Reexamine stool on days 7 and 14 post-treatment, and at 3 months for Taenia infections, to confirm parasitologic cure (all examinations negative) 6.

Nutritional Counseling to Prevent Hypoglycemia

Meal Pattern Recommendations

• Consume three regular meals daily plus 2–3 snacks, avoiding fasting periods longer than 4–5 hours during waking hours 3, 2.
• Each meal and snack should include protein and/or fat with carbohydrates to slow glucose absorption and maintain stable blood glucose levels 3, 2.
• Emphasize carbohydrate sources from vegetables, fruits, legumes, whole grains, and dairy products with higher fiber and lower glycemic load 3.

Specific Dietary Guidance

• Include a bedtime snack containing complex carbohydrates and protein to prevent nocturnal hypoglycemia 3.
• Avoid prolonged fasting for tests, procedures, or skipped meals, as these increase hypoglycemia risk 2, 4.
• Caloric intake should support normal growth and development for a 15-year-old adolescent 3.

Physical Activity Considerations

• Encourage 60 minutes of moderate- to vigorous-intensity aerobic activity daily with muscle-strengthening activities at least 3 days per week 3.
• Before exercise, ensure blood glucose is 90–250 mg/dL and have accessible fast-acting carbohydrates available 3.
• Consume additional carbohydrates before, during, or after prolonged or intense physical activity to prevent exercise-induced hypoglycemia 3.

Follow-Up Plan

Short-Term (1–2 Weeks)

• If any hypoglycemia symptoms occur (especially if glucose was non-fasting or if symptoms were present initially), return immediately for comprehensive evaluation including fasting glucose, insulin, C-peptide, and cortisol levels 1, 2.
• Recheck stool examination on day 7 post-albendazole to assess parasitologic response 6.

Medium-Term (2–4 Weeks)

• Repeat complete blood count and liver enzymes 2 weeks after albendazole administration 5.
• Second stool examination on day 14 post-treatment 6.

Long-Term (3 Months)

• If asymptomatic with no recurrent hypoglycemia and fasting glucose was confirmed, review at routine follow-up visit as initially planned.
• For Taenia infections, perform stool examination at 3 months to confirm cure 6.

Critical Pitfalls to Avoid

• Do not delay hypoglycemia treatment while awaiting laboratory confirmation; treat first based on symptoms and point-of-care glucose 1, 4.
• Do not use protein-rich foods alone to treat acute hypoglycemia, as protein stimulates insulin secretion without promptly raising glucose 1, 2, 4.
• Do not add fat to acute hypoglycemia treatment, as it slows the glycemic response 1, 2.
• Do not assume a single glucose of 56 mg/dL is benign without confirming fasting status and symptom presence 1, 2.
• Do not administer albendazole in the fasted state; always give with a fatty meal to ensure adequate absorption 5.