My daughter was diagnosed about four months ago. Up until recently, she was able to tell when she was “low” from approximately 90 mg/dl [5 mmol/L] on down. Now she can fall as low as 40 mg/dl [2.2 mmol/L] without feeling any signs. Is this normal? Should I really stress that she needs to pay much closer attention to the signals. She is only nine, and I don’t want this disease to become a terrible obstacle in her childhood. Also, I give her only one-quarter of a unit of Humalog in the am and she has a five carb breakfast and a 9:15 am juice box, but by 11:30 am she is 70 mg/dl [3.9 mmol/L] and under, sometimes much under. Why?

Many children and adults have troubles recognizing hypoglycemia. Some can do this easier than others. Often it is very important that she be trained in the symptoms of hypoglycemia so that she can recognize other things besides only being shaky. You should discuss this with your daughter’s diabetes team directly to come up with a plan that will help your daughter better be able to tell when she might have some low sugar readings, paying special attention to moodiness, pallor, inattentiveness, yawning and hunger. This may help. More testing sometimes helps to learn these other cues.

Without being able to give you much direct medical advice, I wondered why her morning breakfast was so low in total carbohydrates. This may be raised, I suspect, and then insulin doses adjusted so that she does not get hypoglycemia so often the rest of the morning. Here again, discuss this with your daughter’s diabetes team and see if you can come up with some alternative ideas.

SB