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January 7, 2002

Blood Tests and Insulin Injections

Question from Chapel Hill, North Carolina, USA:

In your response to the person who asked about obtaining blood sugar levels for normal children throughout the day, it seems odd to me that we do not have the data for this. Although I understand that there might be ethical barriers in obtaining glucose levels in normal children, if we do not know what the normal levels are, then how can we make an informed decision about what the desirable levels should be for children with diabetes?

Answer:

The original request was for the range of normal blood glucose levels in children before each meal and at bedtime by quartiles, and for obvious reasons, these are not readily available. In fact though, the translation of the levels in a child with diabetes into good control only starts with the comparison to normal fasting levels which are well and variously documented.

After that, comes the use of insulins like Humalog or Novolog at mealtimes with carbohydrate counting and the further adjustment of insulin dose according to the premeal blood sugar. Then, when meters are downloaded, there is the retrospective appraisal of histogram and other data and finally of hemoglobin A1c course or the fructosamine level.

DOB
Additional comments from Dr. Larry Deeb:

Aren’t life, medicine and science wonderful? We try to use science, research, etc., when we can and our best guess when we can’t. We know that blood glucose in children is remarkably stable throughout the day; we have some fasting data, but that’s about it.

The National Health and Nutrition Examination Survey, has glucose tolerance data on people 17 years old and above, etc. Unfortunately or fortunately, depending on your point of view, ethics regarding research on healthy children is very strict.

The levels recommended for children with diabetes is not anywhere near what we know to be normal levels. Any recommendation is too high. Why? To keep the child from hypoglycemia and brain damage. We tread the middle ground between two evils, damage from hypoglycemia and damage from hyperglycemia.

I would never approve a study from an ethical basis to learn of glucose patterns in normal populations of children. It would not change diabetes management at the present time. We couldn’t keep glucoses normal if we wanted to.

LD