My seven-year-old daughter has had type 1 diabetes for six years. Recently, her blood sugar has been consistently low. She eats practically the same thing everyday and we have never had a problem until now. I was wondering if she could be in her honeymoon period.

Your letter indicates that your daughter has had diabetes mellitus for six years. If that is true, it is unlikely that you are seeing effects of the “diabetes honeymoon” now to explain recent events of hypoglycemia. The diabetes honeymoon typically begins to occur within the first weeks after the diagnosis is made and after insulin administration has begun in earnest. The typical diabetes honeymoon, as reflected by really tight glucose control without super tight effort, lasts about six to 18 months. I have seen it last nearly four years in several of my patients, but then, it did not reflect “recent” hypoglycemia; rather, these patients were “always” in pretty easy and good glycemic control.

Your letter did not provide more information about her insulin, meal-planning, and activity regimen. You did not indicate who provides the insulin injections or whether she is on a pump and her oversees the insulin administration. You did not indicate your daughter’s overall degree of glucose control as reflected by recent HbA1c determinations.

As you know, at the most basic of levels in the person with diabetes mellitus, glucose control is maintained by the optimal interaction and balance of calorie intake (meal-planning), calorie utilization (exercise), and availability of insulin. If these are off (poor food intake or poor intestinal absorption; increased activity or other metabolic needs; relative increased amounts of insulin), then hypoglycemia results. There are, unfortunately, many other variables that can play into this. You need to bring up these changes you’ve seen with your daughter’s pediatric endocrinology team to look for explanations (some may be very serious) as to your daughter’s apparent new enhanced sensitivity to insulin.

DS

[Editor’s comment:

You also did not explain what specific blood sugar levels you meant by “consistently low.” Clinically speaking, most endocrinologists do not consider blood sugars “low” until they are less than 60 mg/dl [3.3 mmol/L].
BH]