My three and a half year old daughter will hardly eat, and her blood sugar has been low lately. We had to give her glucose gel, apple juice, and gummi bears, but she hasn’t been drinking the juice, or would have just a few gummi bears. I tried explaining what would happen if she doesn’t eat, but she really doesn’t understand. What would be the best way to approach this problem? What else we could give her when her sugar is down like that again?

I think important questions to ask are: How often this is occurring? Does there seem to be some pattern to lower glucose readings? If this is recurring, then an adjustment in her usual doses of insulin may be required and this should be done under the auspices of your own diabetes team.

As for “tricks” to get the glucose up: I generally do not feel you can discuss and rationalize with a pre-schooler — especially a pre-schooler who may be hypoglycemic. So, “damn the torpedos, full speed ahead.” In other words, start just giving her the glucose but I’d approach using the “rule of 15”: 15 grams of carbohydrates (three glucose tablets, about five life-savers; a small Halloween-sized candy bar) followed by rechecking the glucose in 15 minutes to confirm you’re going in the right direction. The glucose gel that you can get at the pharmacy (or even cake frosting) is good because it can be absorbed quickly, even if not well swallowed by the child. a small glass of juice or soda should help. A couple of sticks of regular gum? Talk with your dietitian, and have your Glucagon Emergency Kit at the ready.

Again, if there is a patten that the lows occur generally at specific times of day, you may need to adjust the usual insulin doses or add more protein to preceding meals in order to prevent these episodes from happening.

DS

[Editor’s comment: 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.

SS]