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February 28, 2001

Daily Care

Question from Junction City, Oregon, USA:

My 11 year old son was diagnosed with type 1 diabetes a few weeks ago. Since then, I have spent the majority of my time trying to learn as much as possible about this disease. Both my son and I understand the importance of keeping the blood sugar levels as normal as possible with a good regimen of diet, exercise and insulin doses. My son is very active and plays competitive sports on a regular basis. I can see in just this short period of time that the doctors and dietitians do not share the same motivation that I do with regard to sugar level control. When my son's sugar levels were hovering around 550mg/dl [30.5 mmol/L] they did not seem concerned. I have now adjusted his insulin doses so his sugar levels are between 70 and 150 mg/dl [3.9 and 8.3 mmol/L]. I have read so much about the problems he will have later in life if he continues to have sugar levels that are too high. The doctors have given a recommendation of 100 to 200 mg/dl [5.6 to 11.1 mmol/L] for sugar levels and are not concerned if he is at 300 mg/dl [16.7 mmol/L]. I don't find this acceptable. Am I keeping his levels too low? Are the doctors just more concerned about having him going to low and therefore wanting me to keep him on the high side? Is an 11 year old child supposed to have higher levels than an adult?

Answer:

Best advice would be to direct these same questions in a calm fashion to your diabetes team. The goals should include as normal blood glucose levels as possible but always striving to minimize or prevent hypoglycemia — especially severe episodes of hypoglycemia which needs the help of someone else or produces seizures or unconsciousness. I would agree with your goals but also must say that these are extremely difficult to achieve since our ability to deliver insulin, adjust food and activity — even with insulin pumps and frequent monitoring is not as good as the pancreas’ ability to do the same when undamaged. It still remains our therapeutic goal. Perhaps the diabetes team was only not showing any panic since up-and-down blood glucose levels are a fact of life. But, go back and talk to them to be sure that there is no misunderstanding.

An excellent book is Hanas’ Insulin-Dependent Diabetes in Children, Adolescents and Adults. Very good details and good perspective of the trials and tribulations of diabetes. We have also written something about this in several textbooks and also in several review articles and you can search PubMed to get the exact references from Diabetes Spectrum and Annals of Medicine.

SB