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April 8, 2002

Daily Care

Question from Sioux City, Iowa, USA:

My six year old son, diagnosed with type 1 diabetes at the age of 11 months, has always had uncontrollable blood sugars (up and down), and two years ago he was diagnosed with ADHD, ADD, and mental disabilities. Is it normal for my son to have uncontrollable blood sugar levels?


No. If he had normal blood glucose, of course, he wouldn’t have diabetes. Unfortunately, it is common to have fluctuating blood glucose in treated folks with diabetes as we cannot precisely mimic the moment-to-moment-to-moment regulation that the pancreas can do. However, I will tell you that, in my experience, by far and away the most common cause of wide fluctuations is diminished attention to meal planning/poor calculations or estimates of exchanges or carbohydrate counting. In many families, unfortunately, after a time the parents feel that the patient has had diabetes long enough for the child to be more responsible. I wish that always worked out, but it doesn’t.


[Editor’s comment: I suggest that you set up an appointment with your son’s diabetes team, or if he doesn’t have a pediatric team, ask for a referral. This will give you a chance to review his current treatment plan and discuss changes that might help with control. These days, there are a number of choices in insulin regimens, including basal/bolus programs or an insulin pump. A consultation with an experienced pediatric team will afford you the opportunity for exploring all treatment options and choose the one that will optimize control and be conducive to your son’s lifestyle.