I work in a child and adolescent mental health service. I have just started to see a child who has had lifelong type 1 diabetes. He has been referred because of behavioural problems such as aggression towards people and things. I have read that there is an association between glucose levels and this sort of behaviour in children. Is there anything I can ask which will give an idea about how much the diabetes is influencing the behaviour? Obviously, I don’t think it is all down to the diabetes.

In general, children who have blood sugar values that are higher than their target range, may feel yucky. When they do not feel well, they are probably more irritable, but they are in control of their mood and their behavior.

Children who have blood sugar values that are lower than their target range may experience a wide variety of symptoms, including slowed reaction time, decreased frustration tolerance, decreased concentration, attention and memory, and increased misbehavior/belligerence. These behaviors/symptoms are not in the child’s control, as they are neurologically driven as a result of the lack of glucose in their brain. The treatment is to bring up their blood sugars; figure out ways, with the child and parents, to prevent lows in the future; and discuss the behaviors observed during the time of the low. However, we do not hold children accountable for their behaviors when their blood sugars are low.

For your patient, you might want to review this person’s blood sugar logs to see if there’s a relationship between lows and misbehavior.

JWB