Our eight year-old son has had diabetes since the age of three. During that time, he has never been seen by a pediatric endocrinologist, but has received good to excellent care by two pediatricians with experience in diabetes. We are generally satisfied with his care, but I have had other parents suggest that he visit a large children’s hospital several hours away for an assessment. I’m unsure as to what would be the benefit of such a trip, and frankly, our finances are limited. His A1Cs remain in the 8 to 8.5% range, and we are currently struggling with hypoglycemia unawareness. His pediatrician has suggested letting the sugars run a little higher to compensate for this, but it doesn’t seem to be working. I would like to know if your team recommends such an assessment and why. Our son takes three injections per day, a mixed shot of NPH and Humalog in the morning, Humalog only at dinner, and NPH in the evening. His high sugars tend to be at dinner time, but we are reluctant to adjust his morning NPH too much for fear he’ll experience a low at school, partly because of his unawareness and because the staff aren’t overly watchful. We would appreciate any advice to help with the daily challenges of life with diabetes.

I understand your troubles and your concern about your son. Controlling the blood sugar levels in a eight year old child is a tough challenge, and to me, multiple daily injections (Humalog mixed with NPH before each meal plus NPH at bedtime) is the best therapeutic approach.

Your pediatrician is surely good, but your son’s control could be better with the help of a multidisciplinary pediatric diabetes team. This because an A1c as high as 8-8.5% is not the best control for child relatively close to entering puberty. Quite recently, insulin pump therapy has been used in children this age, even younger, to stabilize blood sugar levels, but again your family would need to have very close contact with a diabetes center comfortable in using the pump with children. Nevertheless, education is, by far, most important in achieving good metabolic control.

To this aim, our website can make the difference through its easy and fast access to news and information regarding diabetes and its management. It can help you keep up-to-date through our answers to various questions and topics. As your son grows up, he will be gradually able to take more responsibility towards self-monitoring and self-management. This will be helpful for better metabolic control.

In the meantime, as your pediatrician has suggested, trying to avoid frank low blood sugar and huge fluctuations of blood sugar levels will be temporary goals. Last but not least, soon there will be new devices and therapeutical opportunities that will make the lives of children with diabetes easier and safer.

MS