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March 20, 2009

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Question from Santa Rosa, California, USA:

Today, while at school, my 10-year-old daughter had a blood sugar reading of 83 mg/dl [4.6 mmol/L] at 9:30 a.m. At 9:50 she had dropped to 62 mg/dl [3.4 mmol/L] so she consumed four glucose tablets. At 10:15 she was 175 mg/dl [9.8 mmol/L]. She called again at 10:45 (her snack time) to say she was 112 mg/dl [6.2 mmol/L]. Are such variances like this in such a short amount of time okay? Diagnosed in October 2008, we are still pretty new to this.

Answer:

Other pediatric endocrinologists may offer a different opinion. You should certainly check with your own diabetes team. Here is my take:

Please keep in mind that a NORMAL blood glucose (before a meal) is generally around 60 to 100 mg/dl [3.3 to 5.6 mmol/L]. Furthermore, “diabetes” is not diagnosed unless the fasting serum glucose is confirmed to be 126 mg/dl [7.0 mmol/L] or more. In addition, your own diabetes team probably gave you a “target glucose” for which to aim. Having said that, all the readings that you gave during the 1 hour 15 minutes that you gave, were all very, very adequate. So, the next question is, “WHY did your daughter check the glucose when it was found to be 62 mg/dl?” If she felt low, then you all treated very appropriately, although you can see that four glucose tablets (how many grams of carbohydrates per tablet or total?) ended up “overtreating” her a bit too much to 175 mg/dl [9.8 mmol/L]. You didn’t indicate her insulin regimen but, clearly, there was some insulin around that began to bring her glucose back down. All in all, with glucose values in these ranges, I would not expect any issue with the glucose fluctuations you noted.

The value of 62 mg/dl needs a little explanation: If your daughter had symptoms of being low, is this recurrent or “low from left field?” If she felt low, you may have a ready explanation that does not require any adjustment in her usual doses. Did her morning activities increase today? Was the morning meal/snack smaller than typical? If your daughter did not have symptoms with the 62 mg/dl [3.4 mmol/L] reading, and it was found “accidentally,” then I’d do a few days of monitoring around the same time to get a feel as to whether this is a real issue that warrants an adjustment. Talk to your own diabetes team since they are more familiar with your daughter’s specific regimen.

DS