My eight-year-old son was diagnosed with type 1 diabetes around Thanksgiving. In what range should we keep his glucose level? I am asking because I am getting conflicting answers. Some say keep on the low side, such as 90 mg/dl [5.0 mmol/L] to 120 mg/dl [6.7 mmol/L]. Others tell us that because he is growing, it needs to be on the high side, such as 150 mg/dl [8.3 mmol/L] to 170 mg/dl [9.4 mmol/L]. I would appreciate another opinion.

In general, for my patients this age with type 1 diabetes, I remind families that a NORMAL serum glucose is generally between 60 mg/dl [3.3 mmol/L] to100 mg/dl [5.6 mmol/L]. The diagnosis of diabetes is not usually made until the glucose is more than 125 mg/dl (“126 mg/dl [7.0 mmol/L] or greater”). The increased urination (and subsequent risk for dehydration), does not typically start until the glucose rises to more than 180 mg/dl [10.0 mmol/L]. Potentially worrisome ketones don’t classically appear until the glucose is over 240 mg/dl [13.3 mmol/L].

So, for this age child, my goal would be to have glucose levels between 80 mg/dl [4.4 mmol/L] to 180 mg/dl [10.0 mmol/L]. As he gets older, the target would be tighter and closer to 70 mg/dl [3.9 mmol/L] to 120 mg/dl [6.7 mmol/L]. The issues of low glucoses revolves around the concerns of serious lows that might interfere with learning. A glucose basement of 80 mg/dl [4.4 mmol/L] gives you lots of “cushion,” to try to prevent glucoses less than 60 mg/dl [3.3 mmol/L].

But YOUR pediatric endocrinologist may have a different philosophy and knows your child. Keep your dialogue with them!

DS