July 24, 1999
Complications, Tight Control
Question from Wisconsin, USA:
My 2 year old’s endocrine doc recently told me that studies have shown that high blood sugars that occur (300’s for instance) on a regular basis (say every morning) in an otherwise fairly well-controlled (mid 100’s) diabetic child will not have the same harming effects for later in life as they would if the child were over the age of 10. I was told I should not be so worried about those highs if she has a good HgbA1c test — the last one she was 7.1%, which he felt was too low for a 2 year old. He wants us to err on the high side instead of risk the lows and potential learning disabilities.
Could you please shed some light on the theory that the highs in a younger child do not have the same effect as they do on an older child in their later years — for example: blindness, nerve damage, kidney, etc.?
Answer:
Although it is somewhat true that the pubertal change of hormones does change the impact of poor metabolic control towards long term diabetes complications, we now know both from animal studies and from the natural history of complications from clinical studies, that metabolic control matters even from the very beginning of the disease.
This doesn’t mean you have to live with the fear of hypoglycemia. To this end, good education towards self management and the use of intensive insulin therapy can be of utmost help.
MS
