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April 11, 2001

Daily Care

Question from Marion, Ohio, USA:

My seven year old son was diagnosed a week ago with type�1 diabetes, and he is taking two shots a day. Yesterday, his counts were 132 mg/dl [7.3 mmol/L], 46 mg/dl [2.6 mmol/L], 57 mg/dl [3.2 mmol/L], and 36 mg/dl [2 mmol/L]. Since he is always low at bedtime, we give him an extra snack and in the morning, he is higher because of this. Our doctor said his blood sugar target should be 150-200 mg/dl [8.3-11.1 mmol/L], but I have several questions: Does blood sugar go higher or lower at night? What is a normal blood sugar count for children? Is it the same as for adults 70-120 mg/dl [3.9-6.7 mmol/L]? What would be a good blood sugar target for a 60 pound seven year old?

Answer:

A normal blood sugar level is around 65-110 mg/dl [3.6-6.1 mmol/L] depending on the laboratory — but that is a good general range. This is different than the target range you should be aiming for in a child with diabetes. A reasonable range for blood sugar control in a child who is aggressively controlled is 80-150 mg/dl [4.4- 8.3 mmol/L] in my practice. This will usually result in a hemoglobin A1c that is less than 7.0%. In younger children, I am not quite that aggressive. It is important to avoid hypoglycemia (low blood sugar) in younger children, so I frequently keep their target range as 100-200 mg/dl [5.6-11.1 mmol/L]. As they get older and can understand the need for aggressive control, and they can recognize low blood sugars with a little more accuracy, it is critical to transition them to a more aggressive target range such as 80-150 mg/dl [4.4-8.3 mmol/L].

Your son’s diabetes team should help decide on appropriate goals for your seven year old and should help you to understand the need for aggressive control. His blood sugars are trending a little low, so I would decrease the amount of insulin you are giving him after consulting a professional on his diabetes team for additional help.

In addition, the ranges for blood sugars aren’t really based on a time of day. Nighttime blood sugar goals should be the same as daytime blood sugar goals, although there are many things that can affect this as your child gets a little older.

MSB