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October 20, 2000

Hypoglycemia

Question from Columbia, South Carolina, USA:

My three and one-half years old daughter was diagnosed with type�1 diabetes at the age of nine months. We have had three to four episodes of unexplained low blood sugars one of which was immediately after an illness. These episodes last a few days during which time we feed her constantly and drastically cut back on her insulin. After this last episode, we cut back from 8 units of L to 3 units, and then, within five to six days we were back to 8 units. During one episode, since we could not get her numbers above 60 mg/ dl [3.3 mmol/L] for several hours, she was hospitalized, and we were told that her liver stores may have been depleted which accounted for lows. Could you explain this to us? Is this common, and can we expect this always? We were able to avoid hospital visits twice times because we used liquid Albuterol (which she sometimes needs for wheezing) since it usually brings up her blood sugars. I know this was probably not what we should do, but we desperately wanted to avoid another trip to the hospital.

Answer:

A number of points here. Young children often have bugs that result in them either not eating or absorbing food poorly with resultant low blood sugars. In such circumstances, a reduction in insulin dose is appropriate with the caveat of more frequent testing and checks for ketones if sugars rise.

If your daughter requires Albuterol for asthma, then, of course, she should have it, but I definitely would not endorse using this as a treatment for low blood sugars. What the latter requires is small amounts of sugar often in the form of sugary drinks, etc. Obviously, all concerned wish to avoid admission to hospital, but if a child refuses to drink and/or the blood glucose levels remain low or fall, then sometimes there is no alternative.

The issue about liver stores relates to the body’s form of starch called glycogen. This is stored in the liver and can be converted to glucose in times of need. However, these stores don’t last too long.

KJR