My four year old son, diagnosed with type 1 diabetes a year ago, has hemoglobin A1c levels from 6.5-7%, but in attempting to maintain good glycemic control, he experiences occasional low blood sugar levels less than 50 mg/dl [2.8 mmol/L] usually related to increased physical activity. Is hypoglycemia unawareness inevitable in a child in which tight control is practiced?

Everyone with diabetes will have some hypoglycemia since our ability to replace insulin is inaccurate, food estimates and activity estimates are merely estimates and there are lots of other vagaries of glucose control such as insulin absorption differences, measurement differences, illness, growth spurts etc. The key issue is not to have too many episodes of hypoglycemia and to be able to prevent all severe episodes, if possible. Usually severe episodes requiring assistance occur when several errors overlap. You should feel comfortable to talk to your own diabetes team about the specific of your child’s management so that you maximize glucose control and minimize hypoglycemia. Frequent monitoring is often the key. Analog insulins often help decrease hypoglycemia and improve immediate post-prandial glycemia at the same time.

SB