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From Poland, Ohio, USA:

My three year old daughter, diagnosed 10 months ago with type 1 diabetes, always has high readings (200-400 mg/dl [11.1-22.2 mmol/L], but doctor tells me not to worry because young children will have higher readings. Is this normal? Also her sugar drops below 80 mg/dl [3.3 mmol/L] in the middle of the night, and her doctor told me to give her an extra snack before she goes to bed to keep it up. Is this the right thing to do?


I think that if you ask 12 pediatric endocrinologists, you will get 13 different approaches. I will try to give you my approach and the thinking behind another.

First of all, it is not "normal" to have blood sugars in the 200-400 mg/dl [11.1-22.2 mmol/L] range. Diabetes is not normal. Is it "acceptable" for the glucose levels to be in this range? Generally no! For a toddler? ---maybe. The (lack of) concern that your doctor seems to have expressed probably relates to the concerns of "too tight" control that could lead to hypoglycemia. That could be a problem for the growing and developing brain of a toddler. We do give toddlers a little bit of leeway on glucose control -- trying to avoid hypoglycemia since there is no unshakable evidence that "tight" glucose control is superior for toddlers.

Nevertheless, I think 200-400 mg/dl [11.1-22.2 mmol/L] glucose readings "always" is way too lax. My goal would be readings that range from 80-180 mg/dl [4.4-10 mmol/L]. I do prefer that the bedtime glucose be greater than 100 mg/dl [5.6 mmol/L], if not greater than 120 mg/dl [6.7 mmol/L] in a toddler, in order to try to prevent early morning hypoglycemia. Of course, you suggest that her sugars "drop" to 80 mg/dl [3.3 mmol/L] in the middle of the night, so she isn't "always" high as you indicated. Also remember that a glucose level of about 240mg/dl [13.3 mmol/L] is the threshold when ketones are easily formed so values greater than that should prompt you to screen the urine for ketones in order to be on the lookout for DKA [diabetic ketoacidosis], which as you know, can be serious and fatal.

You did not indicate her insulin dosages or meal plan or her hemoglobin A1c. For example, if the A1c is very acceptable, then take comfort that the overall glucose levels are likely pretty good, even if they are higher during the times that you check. The A1c reflects the glucose levels all the other times over the prior 8-12 weeks.

If your daughter is followed by a pediatric endocrinologist, express your concerns and foster an on-going dialogue with her diabetes team to see if you can try to lower the glucose levels or why they feel you really have little to worry about now. If you are not followed by a pediatric endocrinologist, please ask for a referral.


Original posting 11 Jun 2002
Posted to Hyperglycemia and DKA


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Last Updated: Tuesday April 06, 2010 15:09:34
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