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January 20, 2011

Hyperglycemia and DKA, School and Daycare

Question from Didsbury, Alberta, Canada:

I have a four-year-old child in my care who has type 1 diabetes. Her blood sugar levels can range from under 3 mmol/L [54 mg/dl] to over 30 mmol/L [540 mg/dl] from one day to the next. I work at a daycare and she is in my care every day. I worry about the severe fluctuations in her levels. I have been instructed that she must have between 15 and 20 grams of carbohydrates for morning snack, 35 to 40 grams of carbohydrates for lunch (which mom provides and can range from 40 to 56 grams of carbohydrates some days) and again 15 to 20 grams of carbohydrates for afternoon snack. I am very diligent counting her carbohydrates, and trying to stay away from sugary snacks at work, but she gets, if you’ll forgive me, crap in her lunch from home. Mom only counts the carbohydrates and subtracts the fiber for her total count, but includes very sugary foods like yogurt tubes or granola bars, or even candy sometimes! There is no protein, which I try to give her for snacks (tuna, for example). I have called mom when her sugars are over 18 mmol/L [324 mg/dl], but unless they are around the high 28s mmol/L [over 500 mg/dl] or so, mom says it is okay, that she will just adjust her insulin. I don’t understand; how this can be right? The young girl gets a shot in the morning, and then at night and gets anywhere from three units of clear with nine units of cloudy (sorry, get the insulin names mixed up!) to over that amount sometimes! I am so concerned that there will be such health problems for this young girl and need some advice from someone as to how I can help her while she is in my care. I can’t control the Fruit Loops and Slurpees she gets at home, but maybe you can give me some advice on what I can do. I am finding it very distressing…


Thank you for your question about the care of young children with diabetes. It is a true challenge to balance food/insulin/activity and the other factors to reach optimal glucose control. As a care provider, you might ask the family if the child is under the care of a children’s diabetes specialist, including a dietitian knowledgeable about the care of young children with diabetes. When you speak with the family, it is best to ask how you can be helpful, and explain that you care about the eating habits of all of the children who are under your care. Although kids with diabetes can eat sweet foods, as with any child, it is important to have a healthy diet overall.

You didn’t mention this, but it is extremely important to understand the treatment of low blood glucose in children with diabetes, and how this particular child acts and looks when her glucose is low. It is very difficult to keep the glucose level stable in a young child with diabetes, and we do the best we can to keep on top of the day’s glucose levels.

There is a book you might want to read that has some helpful information focusing on good nutrition and diabetes control, and the complex nature of this task: Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge. Our web page Books for Parents, Adults and Older Kids also contains several other books, including Understanding Diabetes, 11th Edition by Dr. Peter Chase, that you might find helpful.