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October 23, 1999


Question from Pensacola, Florida, USA:

My 11 year old daughter could be going through puberty. She was diagnosed at the age of 6 years. In the past 2 year she has gone through a dramatic change in her ability to tell when she is low (very low) this has caused us much concern. One instance was at diabetes camp. Even the attendants on duty there were somewhat concerned about her inability to know, and how quickly it happened. This has happened on 5 occasions now. With diabetes in our families we have had to watch this, but she seems to break all the rules we ever knew. Please help!


This sounds like a fairly typical instance of hypoglycemia unawareness. Nowadays there is a great deal of pressure to keep blood sugars as near to normal as possible in order to minimize the chances of the long term complications of diabetes. One of the complications of doing this, however, is that it is easy to skirt the borders of hypoglycemia to the point of becoming unaware of an abnormally low blood sugar. The way to manage this is to let up somewhat on the degree of control; but at the same time to develop a comprehensive profile of blood sugars around the clock so that you can tell when blood sugars are most likely to be low. The insulin and diet regimen needs to be then changed to avoid hypoglycemia as much as possible. Awareness of hypoglycemia will gradually return.