From New Jersey, USA:
Our son is 9 years old and is Type 1, diagnosed 5 years ago. Our question or concern has to do with his fluctuating blood sugar levels. In the same day, for no reason he could go from 50 to 350 and not be sick, overly active or eating incorrect foods. His A1Cs usually come out okay and his endocrinologist is not concerned. We've heard that consistently high sugar levels (above 180 at different times of the day, 28 of the 30 days in November, and he didn't do anything different from his normal routine) can cause complications later in life. We try to monitor his carbs intake and his doctor doesn't believe that he is a brittle diabetic. Increasing his insulin dosage, if only in 1 unit increments, causes severe hypoglycemia. Do you have any suggestions?
Your question raises two important and difficult issues. The first relates to the absolute A1c level. Ideally this should be less than the upper limit of normal for the method used +15%; but this can be achieved by keeping fasting blood sugars uniformly between 80 and 180 mg/dl or by a mix of values that are outside this range. For those who believe that an important reason for the small blood vessel changes that lead to eye and kidney complications is the degree of attachment of glucose to proteins in the vessel wall then the A1c is what matters. This is not yet established and until it is then it is best to assume that a tighter range of blood sugars is the better course.
The second question is whether there are better methods of interpreting the meaning of erratic blood sugars. The following check list may help in discussing the problem with your son's doctor.
- You might consider getting a meter with a substantial memory if you do not already have one. The One Touch Profile and the Accuchek Advantage are examples. With these meters you can download the memory onto your own PC or in the doctor's office and get a printout that gives details of out of range blood sugars in relation to time of day, day of the week etc. You also need to check occasionally that there are no errors of technique in carrying out the readings, this is something to review with your nurse educator.
- From what you write it would seem that you have looked carefully at exercise and food intake as a source of these erratic blood sugars which leaves some kind of stress as the underlying reason. Problems at school may be fairly easy to get at by talking to his teacher; but psychosocial issues in relation to home or friends may need the help of an experienced social worker to unravel.
Immaculate control at this age is sometimes very hard to achieve and it is possible that it would be wise to delay attempts at this for a year or two. Without the actual figures it is hard to say; but this would be another point to discuss with your son's doctor.
Original posting 2 Feb 97
Last Updated: Tuesday April 06, 2010 15:08:54
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