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January 11, 2005

Daily Care, Other

Question from Jackson, Minnesota, USA:

My son just turned three and was diagnosed with type 1 diabetes last month. We are on Lantus at 7 a.m. and Humalog to cover meals. Our doctor wants his numbers between 100 and 200 mg/dl [5.6 to 11.1 mmol/L]. However, I've read that having numbers above this would be okay, so as not to impair cognitive development. Is this correct? I certainly don't want this disease to in any way affect his cognitive development.

Answer:

I believe you are writing from Minnesota. Depending on your geographic location, your child may be being followed at a nearby children’s hospital or university-based pediatric endocrine office. Believe me, they also want your son to do well and maximize his growth and development.

You indicated that you are asking this question “because: The doctor or diabetes team didn’t give me the answer I wanted.”

I don’t think you want your doctor to give you bad advice, do you? I agree with your current doctor that a reasonable goal for your newly diagnosed three year old is a target glucose around 100 to 200 mg/dl [5.6 to 11.1 mmol/L]. I’d actually probably target the upper limit as about 180 mg/dl [10.0 mmol/L]. Much above 180 mg/dl [10.0 mmol/L] and you risk increased urination (which not only is a poor option for optimal nutrition and growth, but which also may interfere with toilet training at this age), increased thirst, and related issues of “flushing calories.”

You are correct, there is little evidence to indicate that glucoses above 200 mg/dl [11.1 mmol/L] interfere with future cognitive abilities, but there is plenty of evidence to indicate that high glucose levels increase risk long-term of eye, kidney, and nerve damage. There actually is a small, but growing, body of evidence to suggest that there may be some learning impairments that correlate to acutely high glucose levels. Low glucose (and I’m typically talking less than about 45 mg/dl [2.5 mmol/L]) may also be associated with learning issues and brain function.

So, don’t be afraid to listen to your child’s doctor.

DS