Today, I had to pick up my 13-year-old from school because they couldn’t keep her blood sugar up high enough. Usually, we can’t keep it down enough. We’ve even detached her pump temporarily and she’s eating carbohydrates. Still, her blood sugar isn’t coming up very much. Have you ever heard of this kind of progression?

I’m not sure I know what you mean by “progression.” Have we seen patients with diabetes (on pumps, not on pumps) have “days” where the glucose just runs low? SURE! Remember, while many things affect blood glucose, the main control boils down to three major issues: insulin, food, and activity, which always need to be kept in balance.

If her intestines are not working right (e.g., just about to get or has a gastrointestinal “bug”), then the food will not be digested and absorbed appropriately. If she had been particularly active today or yesterday, her insulin dosing can be off. Certainly, if there has been spurious or mismatched dosing by shot or through the pump, glucoses could drop.

Why don’t you review the pump settings and the bolus and total daily dose features to see if the insulin dose is correct? I’d watch out for a gastrointestinal illness.

You’ve done the right thing: slow or suspend the pump and feed her. Make sure she is not somehow also getting more insulin by injection. Teenagers have been known to give extra insulin on the sly for a variety of reasons, some of them with an emotional basis.

Now, if this goes on for days on end and her rates really are lower for a sustained period, your pediatric endocrinologist will probably want to test for some conditions, such as thyroid, adrenal, and celiac status, to be certain that there is not some co-morbid issue.

DS