February 21, 2004
Daily Care
Question from Utah, USA:
My son has had type 1 diabetes since he was 15 months old. He is now seven and a half years old. We have been on injections the whole time, mostly of NPH and Humalog. He has good A1c’s between 6.5 and 8. We have a wonderful pediatric endocrinologist and team. I have asked this question a number of times, but feel I am not getting the right answer, or they just don’t think it is a big problem.
At times, my son is quite hyperactive. He shows a lot of silly, out of control behavior. He does “stupid” things that seem to show he isn’t thinking about what he is doing, such as cutting his hair, coloring on walls, etc. He is forgetful and impulsive. He runs from one thing to the next. He is really messy and unorganized. His teachers say he has a very short attention span. I hate to take him somewhere because of something he may do. His endocrinologist suggested I test his blood sugar when he has these crazy episodes as he is probably low. I have found that it is sometimes the case, or that is dropping from a high to a low.
I just don’t know what to do, or if there is anything I should do. We really try to keep him in good control, but as you know it is difficult with someone so young. Would a pump help keep his sugars more level, thus keeping his behaviors more stable?
Answer:
I do think that, nowadays, we may be able to help your son achieve better metabolic control (the last ADA clinical recommendations published in Diabetes Care suppl. 1 2004 require an A1c levels not higher than 6%), as well as a more stable blood sugar profile over the 24 hours through either a pump or the new basal insulin glargine (Lantus). I’d prefer to try glargine first, given the young age of your son, postponing the pump, which is the gold standard for a young child with type 1 diabetes, to an older age around puberty. Your diabetes team will be of great help in working with you on how to best proceed.
MS
