December 22, 2004
Behavior, Hyperglycemia and DKA
Question from Grand Junction, Colorado, USA:
My eight year old daughter is in the third grade. She has had type 1 since she was two years, nine months old. We use Lantus and a NovoLog pen. Her A1c was 7.5. My daughter's blood sugars are very labile and frequently fairly high in the mornings at school despite best efforts, earlier injections and advice from a good pediatrician and a pediatric endocrinologist. When she is high, her behaviors have many characteristics of ADD/ADHD. We recently did a more extensive evaluation with a clinical psychologist and he did get to observe her with high, normal, and mildly low blood sugars. He did identify some problems with aural/verbal memory, but, otherwise, thought her behaviors were blood sugar related. I am looking for research on behaviors in diabetic children when they are out of range and its effect on school performance.
There is extensive research that shows that children with diabetes are at an increased risk of developing a learning disability. Primarily, it is believed that these risks are higher in children diagnosed under the age of five and in children who have experienced frequent and/or severe hypoglycemic episodes. There is also research and clinical experience to show that children’s ability to manage their behavior, their mood and their learning are all impacted by low blood sugars. To my knowledge, there is no evidence of behavioral or other problems related to higher numbers. Children may not feel terrific when their blood sugars are very high, but they are in control of their thoughts and actions during that time.