Is it really “safe” for small children with diabetes to run high blood sugars? I have been assured since my daughter’s diagnosis that running her blood sugars high was safer that risking lows. I have seen conflicting research in this area and a huge variance from one endocrinologist to the next on what is acceptable. I understand the concerns about lows and agree that they must be limited, but, at what cost?

Personally, I try to keep my daughter’s numbers as close to normal as possible, which is not an easy task with a two-year-old, and with the help of a CGMS, we rarely have lows. I know she feels better and is much healthier than when she was running high all of the time and I strongly believe that she will benefit long-term. It’s a lot of work, but very worthwhile to me. I spend a lot of time talking to other parents of small children with diabetes and am often faced with this question. I know what I think and I know what they’ve been told, things like, “Don’t correct unless you hit 400 mg/dl [22.2 mmol/L]; don’t worry about highs until after puberty; small children are ‘protected.'” I just want to know what “the experts” think.

The old research suggested that there was some protection for young children. The new research confirmed from Berlin, Sydney, Brussels, Zurich and many other places refutes this. You are more correct that everyone says that hyperglycemia does not count in young children. What is correct, however, is that the long-term complications take a long time to show up and, so, younger children or even adolescents and young adults rarely have anything very measurable. However, when subtle complications analysis is done, not just symptomatic complications, then the hyperglycemia shows up with poor growth, poor bone mineralization and background retinopathy as well as microalbuminuria (early kidney damage) or asymptomatic nerve damage. The key now is to minimize hyperglycemia while avoiding severe episodes of hypoglycemia. This is a difficult balance as you have said, but still, the key. Frequent blood glucose testing helps to identify such problems and correct them rather than wait for them to get as high as you have suggested. We teach patients and parents to correct at much lower values than your question suggests and we, like many others, do not think it is okay to have such high A1c levels or blood glucose values in the 200 mg/dl [11.1 mmol/L] and above range without making corrections with either food and/or insulin many times. When I hear of professionals saying that this is okay, I always ask what they would do if this were their body or if this were their child – and the answer is 100% – they would always aim for the best possible blood glucose control with the least amount of hypoglycemia, even if that meant more testing, more insulin injections, pumps, etc.

SB