My boyfriend’s daughter is having problems with her blood sugar. At one point, it’s at a normal level, between 90 mg/dl [5.0 mmol/L] to 250 mg/dl [13.9 mmol/L], but when it’s time for her to eat, she’s not hungry and her blood sugar spikes for no apparent reason. Even when her blood sugar is low, she still won’t eat. Is this a true problem or is she just playing games?

The normal level that you quote is not normal, but if the child is a toddler, this may be acceptable. Wide swings in glucose also are not normal and would depend upon why they were happening: exact insulin regimen, dietary planning and compliance, monitoring frequency and analysis, illness, presence or absence of ketones, etc. You may want to arrange to learn more about diabetes, i.e., with Understanding Insulin-Dependent Diabetes by Peter Chase and Insulin-Dependent Diabetes in Children, Adolescents and Adults by Ragnar Hanas, M.D. or even participate in one of this child’s diabetes follow-up visits, if possible, so that you can not only demonstrate knowledge and interest but also learn more specifics.

SB

[Editor’s comment: If the child’s diabetes team includes a psychologist, try to meet with her to discuss strategies for encouraging the girl to eat. When she was much younger, we were advised to give our daughter a sticker each time she cooperated with her blood test, shot, meal and/or snack. At the end of a week or when she had collected 20 stickers, we were to provide some type of treat, such as a book to read, time with someone special, a trip to the playground, etc. If the girl is a young toddler, be sure to discuss with her team the timing of insulin administration. With some toddlers, it is better to give insulin AFTER the child has eaten, especially if you cannot get the child to eat. Finally, try to meet with a dietitian to discuss food options.

BH]