My 11 year old son has had type 1 diabetes for almost 2.5 years, and there have been several occasions when he is experiencing symptoms of a low blood sugar, but when he checks, he is not low. He has double checked to make sure it wasn’t a meter problem. We have done troubleshooting to see if he maybe was coming up from a low, but that isn’t the case and also monitored to see if maybe he was dropping quickly, also not the case though. Have you heard of this before? Do you have an idea of what is going on in his body?

Your son’s story is a common one, and I am sure that he was indeed hypoglycemic at some time before he noticed the symptoms — the usual ‘counteregulatory’ hormonal response brought blood sugars back to normal through a combination of releasing glucose from stored glycogen (glycogenolysis) or by converting protein into glucose (gluconeogenesis). The incidents do raise some other issues, the first of which is that you need to be able to communicate easily and at short notice with his diabetes care team using fax or email, if not with the doctor always; but with the nurse educator and the dietitian. In addition, you need to do quite a lot of blood sugars for a few days including some in the very early morning so that you can understand whether the low blood sugars are related to appetite changes, to vigorous exercise.

Perhaps you to a need to review the dose and type of insulin he is on. If for instance he is not already on it he might be a candidate for Lantus (insulin glargine) as a basal insulin with Humalog or NovoLog after meals, where the dose can be adjusted for appetite and premeal blood sugar. He should probably also be learning to carb count at mealtime too.

DOB