When we switched my 10 year old daughter to the insulin pump, her blood sugars have become much more consistent, and she is doing well with it. The first A1c after being on the pump for a month was 8.5%, down from 9.5%, and I’m sure it’s even better now. She can stay around 100 mg/dl [5.6mmol/L] for a good length of the day and night, but she has approximately four lows per week.

Our definition of a low is below 80 mg/dl [4.4 mmol/L], normal is 80-180 mg/dl [4.4-10 mmol/L], and target is 120 mg/dl [6.7 mmol/L]. These lows are between 60-80 mg/dl [3.3-4.4 mmol/L]. Is this harmful? Is this is a lot of lows? Is the standard definition of a low below 80 mg/dl [4.4 mmol/L]? She doesn’t really feel bad between 70-80 mg/dl [3.9-4.4 mmol/L]. She tests about eight times per day, and I check her at night. The lows are during the day and usually found at a normal check time before a meal. We do work on changing the basal and bolus rates if a pattern develops, but since having a consistent blood sugar at 100 mg/dl [5.6 mmol/L] is so close to 80 mg/dl [4.4 mmol/L], it doesn’t have far to fall to meet our definition of low.

Everyone’s definition of hypoglycemia is somewhat arbitrary and different. In the DCCT, a group of about 50 of us debated such definitions and I think the DCCT definitions are widely available and utilized with some modification for very young children. We frequently use 69 mg/dl [3.8 mmol/L] or below but there are many diabetologists who also use 80 mg/dl [4.4 mmol/L] as a cutoff value for safety reasons — especially in younger children.

You should go back and ask these questions to your diabetes team since they know you and your child the best. If the hypoglycemia is mild and easily treated — and there are no severe or unconscious reactions — then it sounds like you are doing quite well and the hemoglobin A1c values should continue to come down. If the A1c values stay higher than you’d like them to be, you will need to do more detective work in the middle of the night — where basal rates may need more fine-tuning plus also one to two hours after food/snacks to see if these values are much higher than you expect, and therefore boluses need adjustment.

The latest information about brain function from the Children’s Hospital in Zurich suggests that hyperglycemia is also detrimental just as recurrent and severe hypoglycemia is detrimental.

SB
Additional comments from Dr. Donough O’Brien:

You and your 10 year old daughter seem to be doing very well indeed with a prospect of an A1c test that is less than 8% on the pump. Many centers would accept a normal range for blood sugar of 70-120 mg/dl [3.9-6.7 mmol/L] with a low blood sugar defined as less than 60 mg/dl [3.3 mmol/L] or even 50 mg/dl [2.8 mmol/L] as in the DCCT (i.e levels in the 60-80 mg/dl [4.4 mmol/L] range would not indeed be considered hypoglycemic although you’d like to sure that the level wasn’t going even lower).

DOB