My four year old daughter suffers from very erratic blood sugar levels (1.9-31 mmol/L [34-558 mg/dl]), but her doctor does not see it as a problem. She does not show signs of becoming hypoglycemic even when she reaches as low as 1.9 mmol/L [34 mg/dl]. This is extremely worrisome as are her highs as I belive running high can lead to more problems in later life. Do you think I should seek a second opinion?

I understand your concerns, but you have to understand that controlling the blood glucose level in very young children is almost always extremely difficult. The main thing is to avoid symptomatic (and especially, severe) hypoglycaemia and symptoms of high sugars.

The best indicator of long term control is the hemoglobin A1c test which should be done 3-4 monthly. Provided this is under 8% (DCCT corrected), then I think your daughter is doing okay.

Once your daughter is at school with its more predictable schedule, then you and your daughter’s diabetes team will begin to improve blood glucose control. It may be appropriate to consider other insulin regimens, but you should discuss this in conjunction with detailed blood glucose records.

KJR