My four-year-old son has been having symptoms of frequent urination, constant hunger, bed wetting and is, all of a sudden, extremely clingy. I recently took him to his primary care doctor who did a blood sugar check and it was 43 mg/dl [2.4 mmol/L]. They sent me home with a monitor. At home, his blood sugars have ranged from 41 mg/dl [2.3 mmol/L] to 265 mg/dl [14.7 mmol/L], but his A1c test was normal. Should I get a second opinion? What are considered normal blood sugar levels in a four-year-old fasting and two hours after meals? One bedtime reading was 198 mg/dl [11.0 mmol/L]. Is that normal?

If you did the tests with clean fingers and proper technique, those numbers are definitely not normal. Some are too high and some are too low. The symptoms could be early diabetes with a pancreas sometimes making too much and sometimes too little insulin. It would be wise to schedule a follow-up with a pediatric diabetes specialist to review this, get more special testing done and plan appropriate meal planning and follow-up. I would also suggest continuing some more monitoring, perhaps some before and one hour after breakfast, before and one hour after lunch and before and one hour after dinner values for another week or so. This “profile” will give you a better idea of what range of blood sugar is occurring, how often high and how often low. Any values under 60 mg/dl [3.3 mmol/L] should be treated with 4 to 6 ounces of orange juice or similar fast acting sugar to bring his blood sugar back up in case his own pancreas and liver do not respond normally.

SB