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October 3, 2002

Daily Care

Question from Pagosa Springs, Colorado, USA:

My niece, who has a two and a half year old with type�1 diabetes, has been working with a diabetes team, but nothing really seems to help her little son. His sugar level is a constant battle, there never is a even level, and my niece even has to wake up every hour during the night to check his level. They say he is very young and needs to eat to grow so his sugar goes up, she has to give him a shot, and it drops way down. I have seen her poke her son's finger several times in an hour and have seen her give him special tablets of glucose. They just cant seem to get the right dosage for him and said it may be this way for a couple of years. Is there anything that can help her with her son? She also has a 4 month old son at home who is starting to lack attention because she constantly monitoring.

Answer:

Caring for a child at this age with diabetes can be very difficult, and the struggles you have detailed are very common with a child at this age who has diabetes. I’m pleased to hear that your daughter is seeing someone who has experience in treating young children with diabetes which is the best resource for her continued guidance in creating a more normal lifestyle for your niece.

MSB

[Editor’s comment: While I agree that this is a pretty typical scenario in this age group, there are now many options in treatment regimens to alleviate this problem. If your niece is not currently using a basal/bolus insulin regimen or an insulin pump, you might suggest that she ask about these options. They would allow for much lower basal insulin and the bolus insulin could be given after meals based on what he has eaten. Because these regimens are more like how the body works, they tend to making controlling blood sugar levels much easier, even in small children.

In addition, your niece should also ask about the necessity of treating every high blood sugar with extra insulin. Often, this can create a vicious cycle of highs and lows so it might be better to look for patterns over the course of three to four days and then adjust insulin accordingly. Typically, the target range for children in this age group is about 100-200 mg/dl [5.6-11.1 mmol/L] before meals and at bedtime, but this does not mean that every reading will be in this range.

Blood sugar checks are usually done before meals, at bedtime, and perhaps once during the night. Checking several times in an hour seems to me to be overkill and probably won’t yield much useful information.

You and your niece will find Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge and Richard Rubin a great reference for managing a toddler with diabetes. It has many suggestions including some I have described.

SS]