My 12 month old daughter has type 1, diagnosed three months ago. We were doing pretty well and beginning to have fairly stable blood sugars with Lantus and multiple daily injections of NovoLog. Her 90 day average was 200 mg/dl [11.1 mmol/L]. Three weeks ago,she had to get her immunizations. We have not a “good” day since. She is requiring three or four times as much insulin and having wild swings in her readings. She goes over 400 mg/dl [22.2 mmol/L] daily and her average has already jumped up 45 mg/dl [2.5 mmol/L]. Could the stress of the immunizations caused this? Could it be temporary, even after three weeks? Could they have destroyed her few remaining beta cells?

Also, I worry a lot about the effects her high blood sugar and wild swings on her tiny body. I am often told that small children tolerate it better than adults, but I know it couldn’t be good. What should my biggest concerns be about her health now and in the future?

There is no known evidence that immunizations are responsible for causing type 1 diabetes or for the glucose control problems you are experiencing. Many of these immunizations are modified live viruses and, so, the mild virus that you induce certainly can cause some metabolic “stress.” But, it is more likely that she also had a growth spurt and, at the same time, less insulin production of her own and this is the cause of the more difficult glucose control. All of this is highly speculative since there is also no known way to test this theory and you should respond to the blood sugar patterns as best as possible.

Little kids do not tolerate these blood glucose swings better than older folks. They just don’t report as well and we adults need to observe very subtle differences in mood, behavior, etc. The presumed protection of young children from high sugar damage is a theory also disproved by many studies in Australia, Canada, Italy, Sweden and Belgium. To put them all in context, it takes many years for the high sugar damage to become measurable and, thus, the previously presumed “protection” of little children. Years of diabetes is still the best correlate with problems as is long term glucose control using A1c as a marker. So, please keep working with your diabetes team to achieve optimum control.

SB