If my 12 year old son has a blood sugar of 300-400 mg/dl [16.7-22.2 mmol/L], and we give a corrective dose of insulin, what can we reasonably expect of his ability to do homework and take a test at school? Not having diabetes, neither my wife nor I know what a high blood sugar feels like or what it does to your ability to concentrate. We want him to learn how to work despite not feeling great, yet we want to be fair with him.

To begin with your question raises a number of issues that may need to be discussed with both your son’s diabetes care team and his teacher. Blood sugar levels of 300-400 mg/dl [16.7- 22.2 mmol/L] are well above the acceptable range for good control, and it would be important first of all to correlate these with his hemoglobin A1c along with his daily profile of blood sugars to see if these are general, apply primarily to school days, or even more specifically, to ‘test’ days. In the case of generally poor control, you might want to consider, if your son’s not already on it, a regimen of bedtime Lantus (insulin glargine) with Humalog at meals, although this may raise a problem with lunchtime insulin at school

The next step would be to find out if your son is having any special problems at school which in turn lead to anxiety over tests. One of these problems may be that you yourself are so anxious for your son to do well in the test that you may in this way be raising the stress levels and with it the blood sugars and his sense of being unwell.

Finally, I think that you need to consider also who is doing the blood tests. If all the tests are being done by you and your wife or a school nurse, they are almost certainly reliable, but if your son is doing many of the tests, especially the ones showing high values, unsupervised, then this could be a plea for help which needs to be looked at with great sensitivity. If the last situation is a possibility, the medical social worker may be the best person to try to unravel the problem. in any case, it might be a good idea for a time for you to take over as much testing as possible as a gesture of support rather than criticism.

In other words, I think that the ‘not feeling well’ issue can be solved either by better control or by remedying either a school problem or a plea for more support in your son’s diabetes management.

DOB