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September 10, 2008

Hypoglycemia

Question from Spruce Pine, North Carolina, USA:

My daughter was diagnosed with type 1 in May 2002. She has a pump and has been doing well. She will have the usual high or low, but nothing consistent. Over the past five days, she has been low 80% of the time. She will eat supper or a evening snack and then, within 15 minutes, she is low. I called her physician and we have changed her basal rates three times. I know it is late for a honeymoon phase, so what could possibly be causing her to stay low and need a decrease in insulin needs instead of increase? The only change in health is a growth spurt, which normally causes highs.

Answer:

Excess insulin, decreased calories are usually the answer if there is no obvious increase in activity. Occasionally, there are viral illnesses, especially gastrointestinal illnesses, where hypoglycemia occurs. These would all usually be obvious. Sometimes some kids/people take extra insulin and make mistakes about the dosage. Alcohol sometimes also can be associated with sever hypoglycemia because it blocks liver function, but these last two would be very rare in a child the age of yours and are more likely in teens or adults. Adrenal insufficiency, thyroid problems and celiac disease also sometimes co-exist with diabetes and can cause worrisome, recurrent and/or severe hypoglycemia, so these should be checked out with some specific laboratory testing. Keep decreasing the insulin basal and bolus doses and keep close watch with blood glucose levels. If this persists, then ask about these other conditions from your diabetes team.

SB