From Coldwater, Mississippi, USA:
My eight month old son was diagnosed with type 1 when he was four months old. Apparently, he is a very rare case since yours is the only site where I found any information about babies under the age of one with diabetes.
I am confused about the information I have received about highs and lows. My son has had a low of 28 mg/dl [1.6 mmol/L] at least twice in the last four months and he has lows under 80 mg/dl [4.4 mmol/L] at least four or five times a week. One day, he was even under 100 mg/dl [5.6 mmol/L] for about 90% of the day. He has only registered above 600 mg/dl [33.3 mmol/L] twice since being in the hospital and has only had ketones once. His normal range is between 200 and 400 mg/dl [11.1 and 22.2 mmol/L]. The doctors told me to err on the side of high because lows can be more damaging at his age.
How low is too low and how high is too high? At what age do we start trying to keep him more in the 100 to 200 mg/dl [5.6 to 11.1 mmol/L] range? I am concerned about long term affects. Will he have learning disabilities or be susceptible to other diseases because of the diabetes? I don't think my doctor's at LeBohneur even know what to tell me because he is such a rare case.
While relatively uncommon to have type 1 diabetes at such an early age, it is not at all unheard of. I am a bit surprised about the implication that you believe that none of the pediatric endocrinologists at your local children's hospital has cared for a patient this young with type 1 diabetes.
As do many families, you have gotten confused as to what is "normal" and what might be a "target" glucose. In broad terms, a NORMAL serum glucose, NO MATTER THE AGE OF THE PATIENT, is about 60 to 100 mg/dl [3.3 to 5.6 mmol/L]. In NORMAL people, HYPOglycemia does not typically manifest with symptoms until the glucose level gets below about 45 mg/dl [2.5 mmol/L].
But, sometimes confusingly, we give patients TARGET glucose levels to shoot for, which typically are indeed higher than the normal glucose. For an older child, I might give a target of 80 to 180 mg/dl [4.4 to 10.0 mmol/L]; for a middle-schooler/high schooler: 80 to 150 mg/dl [4.4 to 8.3 mmol/L]; for an adult: perhaps 60 to 120 mg/dl [3.3 to 6.7 mmol/L]. But, for a child in this age group, I might aim for a target glucose of 100 to 200 mg/dl [5.6 to 11.1 mmol/L]. If you overshoot sometimes and the glucose is 80 mg/dl [4.4 mmol/L], then, generally, do not to worry as it is still normal and not at all in the more concerningly low ranges.
Your diabetes team seemingly has given you an even broader target of 200 to 400 mg/dl [11.1 to 22.2 mmol/L]. I'm not sure that I would typically advocate that.
In general, when one is too high, the risk is with ketones. I ask my patients to start checking urine (with special strips) or blood (with different special strips PLUS a special meter) when the glucose is more than 240 mg/dl [13.3 mmol/L]. Some clinicians are more lax and do not insist on ketone checking unless the glucose is more than 300 mg/dl [16.7 mmol/L]. High glucose will lead to dehydration rather easily and, if prolonged hyperglycemia, also impaired weight gain in this age group.
Too low is typically under 60 mg/dl [3.3 mmol/L], I think. But, a very RAPID drop in glucose from high to normal might also illicit symptoms of hypoglycemia.
Talk to your own diabetes team and work on target glucoses, calorie intake, etc. You didn't indicate which types of insulin and doses that the baby receives, and this could be an area of focus also.
Original posting 4 Jan 2006
Posted to Daily Care
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