September 9, 1999
Question from the state of Washington, USA:
My 6 1/2 year old son was diagnosed with type 1 diabetes 2 1/2 years ago. He is growing well and participates in both blood glucose testing and insulin injections. We count carbs and adjust insulin and food to account for exercise, excitement, etc. that may effect blood glucose results. He currently checks his blood glucose before meals, at bedtime, and at around 3:45 A.M. and is on 3 shots per day. His last HbA1c was 7.4, and recently his glucose meter averages have been around 140 so we expect his HbA1c to go down a bit more when he is checked later this month. He currently has moderate hypoglycemias (in the low 50’s) every one out of every 5 or 6 blood glucose tests. He seldom rebounds to high numbers as a result of these lows.
My question is: Are the lows a concern for brain development at his age, and if not, how low of an hbA1c should we try for (that is, is around a 7 low enough or should we strive for a lower one)?
I don’t know the reference range for your local Hb1c machine but it sounds as if you are doing fine in this department. However, if your son is having hypos every other day then I think this is probably a bit too often. He may simply need a minor adjustment to his insulin or diet but you should discuss this with your diabetes team. Multiple mild hypos are a concern but have not been definitely shown to be harmful. On the principle that a child’s brain is still developing, however, we usually err on the side of caution while trying to maintain as good blood sugar control as possible.
Additional comments from The Editor:
See also Conventional Versus Intensive Diabetes Therapy in Children with Type 1 Diabetes.