From Los Angeles, California, USA:
One of my 3 1/2 year old identical twin daughters has been diagnosed with Type 1 diabetes 2 months ago. The ADA position on tight control states:
"Tight control is contraindicated in infants under 2 and should be undertaken with extreme caution in children between ages of 2 and 7, because hypoglycemia may impair normal brain development which is not complete until 7 years. The danger of hypoglycemia is greater in infants and children because food intake, activity and adherence to treatment schedules are less predictable than in adults. Because pre-adolescents appear to be relatively protected from micro-vascular complications, the need for tight control might be less than in post-pubertal subjects."
This statement seems to throw some doubt on the benefits of the tight control regimen we've been told to keep her on. Is the ADA stance no longer relevant, or are there radically different approaches to dealing with infants with Type one diabetes?
The ADA position you quoted is what most pediatric diabetes team would be following.
It is a difficult position as a parent to read and hear about "tight" control of diabetes preventing and delaying long-term medical complications of diabetes, and then to be told that "tight" control is not recommended for young children. My recommendation for a 3 year old would be to aim for blood sugars in the 100-200 mg/dl range, where possible. In spite of what books may lead you to believe, you won't be able to always be in this range. Close blood glucose monitoring will help you to try to minimize the lows when you can. When the blood sugar is high, respond to bring the readings back down.
A three year old typically is too unpredictable to aim for more than this. Their food patterns, exercise, sick days, etc., can make for quite a challenge. Unavoidable day-to-day differences in drawing up small doses of insulin can add to the variability.
Remember than the above approach is still more "intensive" than the "conventional" treatment group of the DCCT, but is not pushing to see "normal" blood sugars due to the problems with chronic hypoglycemia in the developing brain of a young child.
Original posting 20 Feb 1998
Posted to Daily Care
Last Updated: Tuesday April 06, 2010 15:08:54
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