June 29, 2000
Hypoglycemia
Question from Michigan, USA:
My 7 year old son was diagnosed with type 1 diabetes almost 2 months ago. He has been doing well overall. He goes low probably on an average of 5-6 times per week as he enters his honeymoon period and we strive to find the correct dosage. He feels his lows probably half the time (his symptom is tired legs), whereas about half the time, it shows up when we are normally taking a reading.
He can be very low (under 40) and still functioning normally (doing homework, running around, etc.). In fact, I have never seem him confused, argumentative, or in any way different acting even though he has frequently been in the 40s and 50s. Is his threshold for feeling the effects of a low just lower than most? Would he likely have to be much lower to actually start showing the kind of effects that would frighten him (and us?) such as confusion, or could he just suddenly pass out? Should I act more decisively to lower his dose, even though he does go high sometimes on his current dose (we are very strict in his diet)? Is this lack of reaction may be giving us a false sense of his well-being?
Answer:
You got the real problem when you affirm at the end of your letter that this lack of reaction might be giving you a false sense of well-being indeed. In my experience, it isn’t unusual at all and actually it has become more and more usual as more patients are following multiple insulin regimens aimed at tighter control of blood sugar levels. This particular phenomenon is called hypoglycemic unawareness and you can read a lot about it at this website. You must act towards prevention of that and to this aim a short period of “relaxed” blood sugar control trough either a ‘less strict’ diet and lower insulin dosage generally will be able to ameliorate these symptoms. Afterwards, try to handle insulin, diet and exercise in order not to have blood sugars lower than 80-90mg/dl over the day. Lower levels don’t change anything as far as complications or growth whilst they certainly change the quality of life.
MS
