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From Maine, USA:

My 13 year old daughter was diagnosed 3 months ago and is apparently in the honeymoon phase. She tries to hover around blood glucose levels of 90 or less, often dipping to the 50's before lunch. I was concerned to read a recent question about research that associates hypoglycemia with cognitive deficits. Should I encourage her to be less self-satisfied under 80?


Hypoglycemia of varying severity is a common side-effect of insulin therapy, although the frequency is difficult to estimate with accuracy unless confined to severe episodes. Changes in cognitive functions of a variable degree may occur in diabetic children who have experienced recurrent severe hypos (blood sugar generally lower than 30's for a long period of time) and, in some cases, may be sufficiently profound as to significantly affect a patient's ability to function in everyday life. In these cases, learning, attention, decisions, mental flexibility and IQ performances can be altered during severe hypoglycemia, with women less affected in neuropsychologic function than men. Mild hypoglycemia (lower than 50's but not than 30's for a short period of time) generally determines minor symptoms such as edginess, irritability and depression.

Do not forget that we all respond differently to hypoglycemia. Some kids are going low at a blood sugar value of 65's, while other kids need to be at much lower blood sugar level before they become symptomatic. Furthermore, near-hypoglycemia (symptoms of hypoglycemia with no chemical hypoglycemia) can affect many IDDM patients with poor metabolic control, although no relationship seems to exist between blood sugar control and cognitive deficit.

Last but not least, it now more common, with the introduction of intensive insulin treatment, to observe patients who have had diabetes for some time and have had persistent low levels of glycohemoglobin who show blunted ability to recognize and give the appropriate signals of impending low glycemia leaving the patient open to severe hypoglycemia. This "resetting" of central nervous system is a result of a chronic mild hypoglycemia and therefore, in the case of your daughter, I would be well satisfied with a pre-meal blood glucose level of around 80 mg/dl.


Original posting 3 May 97


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Last Updated: Tuesday April 06, 2010 15:08:54
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