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Question:

From Rockford, Illinois, USA:

My 12 year old son was diagnosed with type 1 diabetes a year ago. How many blood sugars (causing reactions) below 70 mg/dl [3.9 mmol/L]) are acceptable per week for good control?

Answer:

I think that if you ask a dozen endocrinologists this question (and perhaps you have), you'll get 13 different answers.

First, I think we have to agree on what is an "insulin reaction." A normal blood sugar is generally between 60 and 125 mg/dl [3.3-6.9 mmol/L] (although for most people without diabetes, we expect the upper value to be no greater than 110 mg/dl [6.1 mmol/L], fasting). While this is a normal value, your son's diabetes team has probably given you a glucose that may be about 70 to150 mg/dl [3.9 to 8.3 mmol/L] (or 180 mg/dl [10 mmol/L]). Don't be confused with the target as being "normal." Very often, we give someone with diabetes a higher limit for the low end, in order to provide a bit of "cushion" to prepare you for hypoglycemia, but a glucose value of 70 mg/dl [3.9 mmol/L] is very normal, I'd be thrilled if my patients had values of 70 mg/dl [3.9 mmol/L] all the time.

I would say an "insulin reaction" encompasses the symptoms of severe hypoglycemia, such as confusion, change in level of consciousness, or seizure. This most often occurs with glucose values less than about 45 mg/dl [2.5 mmol/L], but can occur at higher levels, perhaps if the glucose rate is falling quickly. How many of these are acceptable? Well, none, but they are not unavoidable. The risk of severe hypoglycemia increases threefold with tighter glucose control. However, the risk of complications may approach 100% with poor glycemic control.

So, if a patient tells me that they have a bit of shakiness, sweatiness, hunger, dizziness, headache that easily goes away with a small snack or 15 grams of carbohydrates, and that this occurs once or twice per week, I generally accept that, especially if the hemoglobin A1c is under about 8%. More significant reactions that occur more frequently suggest "too tight" control and need to be discussed with your son's diabetes team to think about modifying the balance and relationship among the meal plan, insulin dosage, and exercise.

DS

DTQ-20011016102310
Original posting 22 Oct 2001
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:09:26
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