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May 7, 2002

Daily Care

Question from Waldron, Arkansas, USA:

My four year old daughter’s (diagnosed with type 1 diabetes when she was 10 months old) last A1c was 9.3%, but in the past few weeks, she has been having several lows (as low as 25 mg/dl [1.4 mmol/L]). One morning, she ate a good breakfast and, less than 2 hours later, her sugar had dropped to 36 mg/dl [2 mmol/L]. She drank juice and ate a little and it went back up to 246 mg/dl [13.7 mmol/L], but three hours later, it went back down to 30 mg/dl [1.7 mmol/L], Of course, we got it back up. Do you think her pancreas (by some miracle) may be producing insulin? That is the only explanation I can figure for making her sugar go so low. Is there some kind of test that can tell if it is?


From: DTeam Staff

Even if your little daughter had some other form of type 1 diabetes than the common type 1A (autoimmune) form, I think that it would be very unlikely indeed that the current low blood sugars represent any restoration of islet cell function. I think it more probable that at her last visit to the clinic, when she had a ahemoglobin A1c of 9.3% (which is rather high) that the insulin was increased at a time when the weather was encouraging more activity and less appetite.

I think that you should start by developing a rather detailed profile over two or three days of her pre-meal and middle of the night blood sugars and then discuss what changes in diet and insulin dose need to be made with her nurse educator and dietitian. At the same time, if you are not already doing it, you might talk about using bed time Lantus (insulin glargine) for basal insulin needs and after meal Humalog, adjusting the dose for the pre-meal blood sugar and amount of carb actually consumed.