Hello, Read your concern There are many causes for which your grandaughter may have these symptoms. Please get her blood sugar level checked to rule out diabetes which may cause such symtoms. Also ,such symptoms may be seen in a condition known as insulinoma which is a tumour of the beta cells of the pancrease. This tumour is characterised by whipple s triad where signs and symptoms of hypoglycaemia are seen with blood glucose levels lower than 45mg/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 hypoglycaemia as well. A proinsulin level is also adviced , if possible. Diagnostic imaging test would include USG,CT scan or an MRI to trace the tumour,if any. It will be appreciated if you could provide more details about her symptoms at the time of tremor.As for eg: 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. Regards, Dr.Pallavi Jain