A couple of weeks ago, my 10 year old daughter, who has type 1 diabetes, had a seizure in her sleep, and I do not know how long she was seizing before I found her. While waiting for the ambulance, I checked her blood sugar while she was seizing which was 57 mg/dl [3.2 mmol/L] (pretty normal for her). We got her to the hospital where they gave her D50 twice, and it took more than 24 hours to get her back on track. She had an EEG about three days later which showed that she did have a seizure and was abnormal, so she saw a neurologist who he said this isn’t considered epilepsy unless she has more than one seizure, and her endocrinologist says the seizure was not related to her diabetes. What could this be? Her blood sugar usually runs from about 50 to 350 mg/dl [2.8-19.4 mmol/L], and we’re checking about putting her on the pump to regulate it.

You obviously do not know what the blood glucose levels was during the start of the seizures. Fifty-seven mg/dl [3.2 mmol/L] is certainly below normal range and should raise the high possibility that the seizure was caused by hypoglycemia.

You should be doing some overnight blood glucose monitoring to see if this is a pattern. Do some before and after meal blood glucose readings as well as some through the night to answer such questions and then present this data to the diabetes team to review with you. Often control can be improved dramatically when one is convulsing a twice a day insulin regimen by going to three or four injections per day.

Insulin provided at dinnertime often peaks in the middle of the night and moving the dose from super to bedtime NPH or Lente also moves the peak to closer to the next morning. Bedtime Lantus (insulin glargine) would also be an option if changing the timing does not work. Whether or not an insulin pump is a correct option would require a great deal more monitoring and analysis. Please go back to your daughter’s diabetes team with and arrange for more detailed consultation about what else needs to be done so you can feel comfortable with your options.

SB

[Editor’s comment: Your daughter’s situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System.

WWQ]