My seven year old boy, who was diagnosed with type 1 diabetes when he was two, is very active, and although I try very hard to keep his sugars pretty much controlled, sometimes I just cannot get his sugars to stay in the normal range. Is there anything I could do or try when this situation arises?

Since I don’t know your son’s hemoglobin A1c, I am unable to suggest a change, if any, in his diabetes management. Certainly, there is an increased risk of poor control if wide fluctuations of blood sugar levels occur frequently over the days.

Good management depends upon attention to diet, exercise, insulin administration, and glucose readings. Tight control can lead, beyond a much better quality of life, to up to a 70% decrease in risk of diabetes related kidney, eye, and nerve problems. I should point out that the degree of glucose control to achieve that was not “excellent” control or normal glucose values, but simply “good” control — to keep the HbA1c less than about 1% above the upper level of normal for the lab performing the test.

The best way to achieve all that is a proper diabetes education for the child with diabetes and family on how to self-manage. If your son does not already have a referral to a pediatric diabetes team, I suggest you ask for one.

MS