My son was diagnosed when he was 19 month old. Now, he is 32 months old. Since his diagnosis, we have seen his blood sugar in the 2.3 to 2.6 mmol/L [41 to 47 mmol/L] range five times. I am worried that these periods of low glucoses could have caused brain damage, which I have been reading about. Do I have to worry about that? Does brain damage occur every time one’s blood glucose drops below 3.0 mmol/L [54 mg/dl] or does it depend on long the blood glucose remains that low? He has never encountered serious signs of hypoglycemia. My son does not have symptoms even when his blood glucose is as low as 2.0 or 3.0 mmol/L [36 or 54 mg/dl], so we check him often to prevent lows.

Hypoglycemia unawareness is very common, especially in very young children. You are correct that a good strategy of prevention includes frequent blood glucose monitoring and also periodic overnight monitoring as well, even though this is not so practical on a daily basis. Most cases of brain damage with hypoglycemia occur in prolonged hypoglycemia with unconsciousness or with seizure, so the milder cases are not as worrisome as the more severe episodes. However, goals of treatment always should include methods and strategies to prevent and minimize hypoglycemia of any kind. Having said that, recent research from the Zurich Children’s Hospital from Professor Schoenle documents elegantly that high sugars are much more damaging to the brain than even severe hypoglycemic episodes over time. Nevertheless, you should work closely with your diabetes team to optimize glucose control while minimizing both high and low blood glucoses as much as possible.

SB