June 10, 1999
Question from Olathe, Kansas, USA:
My 2 year old son was recently diagnosed with Type 1 diabetes. We were told by our diabetes team that we should try to keep his blood sugar between 70 – 200 with 80 – 120 being ideal. They wanted us to avoid “too” tight of control because of his age. If his sugars consistently run in the 120 – 200 range, will he be at a higher risk for complications? Will we have a better chance of avoiding complications with tighter control? How early can complications start showing up?
The problem with a 2 year old is that they can be very volatile in terms of activity, appetite, susceptibility to stress, etc. All of this makes it much more difficult to control blood sugars. These days, of course, there is great emphasis on good control whatever the age as being the surest way to avoid late complications. At the same time if you push too hard there is the risk of hypoglycemia which can do much more harm in infancy. So, as your team suggests, you do the best you can, to anticipate and prevent hypoglycemia, take lots of blood sugars, and get confident about making small alterations in the insulin dose.