My 15 year old niece was just diagnosed with type 1 diabetes two days ago. After about three days of “flu symptoms” (excessive drinking, peeing, and vomiting), she was getting lethargic and was taken to the ER. Her initial blood sugar level was 2400 mg/dl [133.3 mmol/L], but she fortunately did not go into a coma. After two days, it went down to 220 mg/dl [12.2 mmol/L], and then today went back up to 390 mg/dl [21.7 mmol/L]. When should she expect to get a stable reading?

I know this is a stressful time for everyone in the family. I hope that your family is working with a team of healthcare workers skilled and practiced in managing a child (and the family of a child) with diabetes. If not, they may wish to ask for a referral to a pediatric endocrinologist, which will likely be in the nearest large metropolitan area and/or university medical center.

Your niece had severe hyperglycemia and was not only at risk of cerebral edema (brain swelling), but also stroke. (Blood is supposed to flow freely. Imagine how thick and syrupy her blood was.) Right now, the family needs to read up a lot on type 1 diabetes and follow up with an education team to address your questions and anticipate what’s to happen next.

“Stable” blood sugars can be anticipated when she gets into her own usual routine of exercise and activities and meal planning. If she has lost a fair amount of weight before she was diagnosed, she very likely will soon be eating a lot as her body tries to “catch back up.” Her insulin doses will be increased along the way to try to keep pace.

As she catches up and her appetite decreases somewhat, and she gets into her routine, she likely will then enter the honeymoon phase. This usually occurs within the first four to six weeks of diagnosis and initial treatment with insulin. At that point, her insulin requirements may actually decrease as she may experience hypoglycemia. During the “honeymoon” her sugars will eventually be a bit more consistent, but do not expect perfectly normal sugars all the time.

DS