On three occasions during the last six months, our daughter (who has type 1 diabetes) has woken up looking perfectly fine but dizzy, nauseous, disoriented and not being able to speak or remember anything (not even her name). On two of the occasions, her blood sugar was normal, and this last time she had a reading of 42 mg/dl [ 2.3 mmol/L]. Every time, I thought that these symptoms could by caused by hypoglycemia so I gave her juice and other things to bring her blood sugar up. All three times, the symptoms have persisted for three to five hours even after her blood sugar is normal or above. On each occasions we called our endocrinologist who said they were caused by hypoglycemia.

This really scares us as parents, and worse, we don’t really know how to go about fixing it. We have spoken to our friends who have children with diabetes, and none of them have experienced anything like this. Please help.

Most likely, the hypoglycemia is occurring for several hours before you are checking the actual blood glucose level. You are seeing the aftereffects of this hypoglycemia and should do some detective work (what we call overnight profiles) every few hours to document where the lows start. Then, you should adjust the appropriate food and/or insulin to help decrease these hypo episodes.

If your daughter is using suppertime insulin, this should be decreased and moved to bedtime. Consideration for Lantus (insulin glargine) would be helpful in such a situation since it has less of a peak than NPH or Lente for overnight glucose coverage. Either way you should share this with your daughter’s diabetes team and problem solve based on lots of overnight blood glucose testing.

SB

[Editor’s comment: Your daughter’s situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System.

SS]