Our 2 year old daughter was just diagnosed with type 1. We are trying to keep her blood sugar level between 100 and 200. I have two questions: (1) Is there damage, and if so what type, by keeping her blood sugar at 150-200? (2) She complains about being hungry and feeling pain when her blood sugar level is 150-200 when she hasn’t had insulin for 14-15 hours (overnight). Is it possible she just lacks the insulin to process the sugar she has? Is there a test for insulin in the blood that could tell us this?

Managing diabetes in a 2 year old can be a frustrating process. It is unlikely that she will have any damage from a blood sugar level of 150-200 at this young age. However, as she grows — especially into her teen years, more aggressive control of her blood sugar is important to help decrease her risk for long-term complications of diabetes. Other than the routine testing of blood sugars every day and a routine Hemoglobin A1c (which typically is monitored every 3 months in this age group), there is usually no other testing that is helpful in controlling diabetes at this age. Usually, one uses a longer acting insulin such as NPH, Lente, or Ultralente insulin at dinner or bedtime to provide for insulin needs overnight — thus, your daughter really is not “without” insulin for the 14-15 intervening hours of sleep.

MSB