My seven year old daughter is on an insulin pump which is managed by the nurse at school. Currently, she is checking blood glucose about six times a day, and at the beginning of the year, I adjusted the basal rates and insulin to carb ratios. However, with the adjustments came low blood sugars (some in the 30-50 mg/dl [11.7-2.8 mmol/L] range) usually around 9:00 am. Now she is afraid of going low around 9:00 am even when blood sugars are in range or a little high. Is there any way I can assure her about not going low at this time?

Your daughters’ worries are to be expected, especially since she really did go low for a while. The best thing to do right now is to explain to her, in as matter-of-fact a way as possible, what caused her lows previously. Then have her count the days she has not had lows (It sounds like she’d count at least 20 school days if not more). Then ask her based on this “data” how likely she thinks it is for her to go low at 9:00 am now. She probably will not see it as a likely event. Finally, ask her what she can do if she does go low. (this is like planning for the “what if the worst thing really did happen?” question). Assuring her that a safe plan is in place just in case she does have a low at school will be important for that.

JWB