My recently diagnosed three year old daughter has levels above 250 mg/dl [13.9 mmol/L] at least two out of the five tests each day, and we can’t seem to get her better regulated. Our team says this is quite normal with young children and her numbers may be as good as they are going to get at this age. How much does this increase her risk of complications? How long being “high” is too high? What are the current opinions about the research that shows that the years before puberty do not count toward long term complications? What is your opinion?

The original research came from the Children’s Hospital in Pittsburgh from an excellent group of scientists. Their data have been refuted by new data from Sydney Australia, Berlin Germany, Brussels Belgium and Leicester UK, and we now believe that there is likely an acceleration of problems with diabetes complications at or around puberty. but that the years of diabetes before puberty do really matter. A key issue remains that the long time for complications to be observed since they reflect many years of high sugars. So, we would state the situation in a different fashion: Glucose control matters even for little kids. The ability to actually measure and detect problems in preadolescents is very difficult.

The worse the control of glucose values, the worse growth is likely to be and the more likely complications will be seen as a teenagers and young adults. The other problem with glucose control remains being able to prevent severe episodes of hypoglycemia.

This is always the balance, not having severe episodes of hypoglycemia while avoiding many long periods with hyperglycemia. hemoglobin A1c gives a great way to determine how one is doing even though there are different definitions of “tight control.” Many children around the world can get and maintain safe glucose control without excessive or severe episodes of hypoglycemia while also keeping A1c levels below 7-7.5% using DCCT A1c standards.

SB