My three year old son was diagnosed with type 1 diabetes last year. Since then, I have had an A1c and insulin level run on myself due to many low blood sugars. My A1c was4.2% and my insulin level was 4 (apparently lower than normal). How can this be with low blood sugars? My doctor said we need to watch this, but what could it mean?

Your A1c level, which is at the lower range of normal values, reflects the average blood sugar levels over a period of time of up to two months. Your value might mean that your sugar levels have been normalfor the most part, if not low sometimes during the three months before the A1c determination. That said, your fasting insulin level might also be in the lower range because of concurrent lower blood sugar that has shut off insulin secretion (a close regulatory feed back exists between sugar level and beta cell secretion of insulin), and only an intravenous glucose tolerance test or a glucagon test might beof help in determining your pancreatic insulin secretion.

Furthermore, given your risk for type 1 diabetes as mother of a child who has it, I’d check also for islet cell antibodies in order to exclude a possible prediabetic condition that might be responsible for your low blood sugars.

MS