My two year old daughter was recently diagnosed with type 1 diabetes after being admitted to the hospital for DKA with a blood sugar of 1344 mg/dl [74.7 mmol/L]. I am managing her blood sugar at home now, but lately it seems as though her blood sugars have been low (40-80 mg/dl [2.2-4.4 mmol/L]), and when she got sick recently, I did not give her any Insulin and her blood sugars were normal.

Could she just be going through her honeymoon period? Is there a possibility that she could have type 2 diabetes? Is there a way for doctors to distinguish between type 1 and type 2 when it is a child who is being diagnosed?

Two year olds almost always have type 1 diabetes. This could be a honeymoon or remission phase you are experiencing, although this is also less common in preschoolers than in older children and adults. During an illness, especially a gastrointestinal bug, sometimes there is hypoglycemia rather than hyperglycemia because food is not being absorbed. Respiratory illnesses usually are associated with hyperglycemia. Both types can have ketones, however.

Blood glucose should be guide as to how you respond to either illness. You should be in close contact with your diabetes team to let them assist with insulin dose adjustments during this period of changing needs. Over time, however, likely that the insulin requirement will return and gradually increase with growth.

SB