My friend’s five year old granddaughter has type�1 diabetes, diagnosed about a year ago and treated with injections three times a day. However, her blood sugars are always either off the charts (high) or below 50 mg/dl [2.8 mmol/L], and she has been having seizures really bad about three times a month. If they can’t get her numbers regular, what are chances of long term effects? What are the chances of death?

I think a couple of other issues need to be addressed. First, in answer to your question, wide and dramatic fluctuations in blood glucose readings like that, certainly to the point of having seizures/convulsions are not good for normal growth and academic development. While fortunately uncommon, severe hypoglycemia can be associated with death. So I think three seizures a month is unacceptable.

I think that a couple of questions need to be answered: Has she been assessed for an underlying seizure disorder or epilepsy? What is her insulin regimen? Combinations of NPH (or Lente) with Regular or other short-acting insulin sometimes leads to insulin “peaks”. Is she following her meal plan in a rigid, steady manner? Perhaps this child’s diabetes team would want to consider a different regimen of insulin that offers less “peaks” and allows a bit more flexibility in meal planning. They might consider Ultralente or Lantus (insulin glargine). However, then the girl would require to receive some dose of rapid-acting insulin with most every meal. An insulin pump is also a consideration to “smooth out” glucose readings.

Please have your friends discuss this with their daughter’s diabetes team. She may need a referral to a pediatric diabetes team, if she is not already followed by one.

DS