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May 29, 2000

Hypoglycemia, Tight Control

Question from Rockville, Maryland, USA:

My daughter was diagnosed with Type 1 diabetes at the age of 3 and a quarter. She has had it now for 3 years. Her A1C tests have been between 6 and 8.5. Her average test is usually hovering around 7. Her father and I have been trying to keep her in tight control to prevent future complications, but we have just been told that frequent bouts of low blood sugars could cause brain damage. She has lows of 45-60 approximately 5-10 times a month but we usually catch it before it progresses beyond confusion. What is considered frequent low blood sugars? Should we be working on keeping the average of the blood sugars low, or should we be working in a higher range to keep periodic lows away? What is the goal we should be trying to achieve for an almost 6 1/2 year old?

Answer:

You have asked some very good questions. Regarding how do I define “too many lows”, I would say that we would try to help people living with diabetes to not have more than 1 episode per week if at all possible. Not only is it dangerous, it is frightening to feel that way and interrupts quality of life.

Managing type 1 diabetes is much like walking a tight rope: a unit of insulin too much, a piece of bread too little, and your daughter can fall off and have a low. We usually advice young patients to work towards a hemoglobin A1c of 7.5-8 without lows. If having a lower A1c is only possible by having many lows, the “cost” just doesn’t seem worth it. New insulins, such as lispro, make it possible to find a closer match for carbohydrates without having an insulin that stays around too long. Lispro for food with a longer acting background insulin can offer some welcome flexibility without increasing risk of low blood sugar. I would also recommend reading a wonderful book, Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace, for additional support about the family dynamics of food and diabetes.

KS