From Fleming, Ohio, USA:
Our seven year old son was diagnosed with type 1 diabetes four and a half years ago., and we occasionally have episodes of either high or low glucose readings for no apparent reason. These periods may run for up to a half day or so. We understand that the highs might be caused by stress, illness, insulin leaking out, and so on. The lows however are quite perplexing to us. How can our son, given the same insulin amounts at the same time of day and eating basically the same carbs, fats, and proteins at each meal every day, run low with no unusual amount of exercise? He will run low for hours, seemingly, no matter how many carbs we give him. On the last occasion, we gave him almost an additional whole days worth of carbs over a few hours and he continued to run low! What might be causing this? We have been told that he is most likely not in the honeymoon period. Is it true that insulin absorption rate may varying up to 40% from shot to shot?
Having realistic goals for the treatment of diabetes is very important. You will occasionally see a high day or a day where you struggle with lows no matter how hard you work to control blood sugars. The blood sugar can be affected by many variables including food intake, insulin dosing, stress, hormonal factors, as well as many other factors we may not yet know about.
Work to minimize problems on the days where you are struggling for better diabetes control, and work to minimize the frequency of those days. You will never be able to totally eliminate the occasional difficult day though. If you are beginning to struggle with higher blood sugars and an increasing insulin dose is needed to help control those sugars, your son is likely out of the honeymoon period. You are correct that insulin absorption can vary.
[Editor's comment: I agree with Dr. Brown. What you need to look at is overall control and not the occasional times when you have a period of highs or lows. The current recommendation is to strive for a hemoglobin A1c as close to normal as possible, without frequent hypoglycemia.
You son's situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what's happening in more detail. See The Continuous Glucose Monitoring System and ask his endocrinologist about it. SS]
Original posting 24 Feb 2001
Posted to Daily Care
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