Can anyone point me to a good book or web site about what is “Normal” for a 6 year old with diabetes. For example, after she eats her bloog sugar levels can be 300 to 400 and than about 3 hours after she eats they are back down in the low 100’s. Is this normal for a type 1 diabetic?
I don’t think there is such a book. I learned a lot about blood sugar from the book (and website) Blood Sugar 101. It’s actually geared toward T2, so a lot of it wasn’t relevant, but the stuff that was pertinent was good. I wouldn’t be pleased if my 10 year old was raising so high. I suggest you talk to your CDE about adjusting dosing.
Try juvenation.com it’s for type 1’s and they have a lot of parents and people more than willing to answer questions and give support, just like here. You didn’t say how you and her are treating??? MDI?? Pump?? I am not six, but I am type 1 and for me the way I keep post meal numbers down is to inject my fast acting insulin (Novolog) about a 1/2 hour to 45 minutes before I eat. Other wise I go high like your child and down to normal.
I don’t know of any books on the subject, but her readings aren’t healthy. Aside from 300-400 being dangerously high, dropping down 200-300 points is hard on her body.
Non-diabetic children tend to have lower BG than non-diabetic adults.
Timing of insulin is as important as doses. Both may need adjusting. Difficult to get doses correct for kids with their growth spurts & activity level. Please speak with her doctor.
My Doctor say if I get to 400 to call him. 400 is to high and will cause organ damage you need to talk to a Doctor on proper way to use insulin.
maybe ask your doctor, or a doc that specializes in young diabetics.I think growing kids are different that adults.
Try giving the insulin earlier or later depending on the glycemic index of the food, but consult her physician first.
Try Smart Pumping by Howard Wolpert. I read it recently as a review of good topics, but for a new diabetic I feel like it can be a gold mine, EVEN IF you are not pumping. There is a lot of smart info about Type 1 Diabetes, I highly recommend it.
I have a 2 year old daughter and her numbers are very similar to your daughters numbers. The doctor explained to me that adults are treated way differently than small children and react very differently. The biggest difference and the reason the small children have more dramatic highs after a meal is that their bodies are differently and more dramatically effected by carbs. In addition, if you are like us we don’t treat her with her fast-acting insulin until the meal is over so we can accurately treat her for what she eats. The adults I know that are Type 1 treat prior to eating thus having the insulin on board to treat for the carbs before they get into the blood. We cannot treat prior to a meal b/c we never know if she will eat what we think or balk at it & go a different route.
Another thing I was told was that although a 6-7% HbA1c is normal for adults 8-9% is our goal. Little Children w/ lower averages were found to have too many “low” episodes leading to cell damage in their brains. I was told that as they get older we can slowly reign in her blood sugars, but that the highs will not be damaging her body (and organs) as much as the lows will kill her brain. Or as they put it “dumb her down”.
This is what was explained to me. I am no doctor and do not claim to be. We attend St. Louis Children’s Endo Department which was ranked in the top 10 of best children’s endo dept - so not like some crackpot endo office. I still wish and strive to have better control with my daughter and would like to see her 8.7% HbA1c come down to below 8%. I hope this helps.
Must be so difficult dosing insulin for a child not knowing how much or what she’ll actually eat.
Surprised to learn that the A1c goal for young children is between 8-9. Seems that an average BG of 183-212 is awfully high. At what age is the goal lowered?
When I was 5, My doctor wanted mine to be 7-7.5. I got a 6.9 when I was around 10 years old and they said it was a little too low, but I’ve never heard any doctor say 8-9.
and I don’t THINK I’m brain damaged >_>
The children’s hospital of eastern ontario (CHEO) also has a very good endocrinology department and David’s endo is a teaching professor of endocrinology at the University of Ottawa.
CHEO’s recommendations:
Less than 5 years of age, A1c goal less than 9%
Less than 12 years of age but greater than 5 years of age, A1c goal less than 8%
Greater than 12 years of age, A1c goal less than 7%
This goal setting info is printed on a wallet size card that is updated at each clinic visit with the child’s current A1c result. So targets right there, on a wallet size card, as a reminder, every quarterly visit.
Cheryl
My 3-year-old son has a prescribed range of 80-180 during the day, 110-210 at night. It is definitely not good to have blood sugars as high as you describe, but it really depends on when you’re giving her the insulin. Are you giving her insulin before she eats her meal, or after? If it’s after, then the sugars you are describing are understandable (but still not healthy), and you really should be giving the insulin to her before she eats. Recommended is to give her insulin for the number of carbs she intends to eat 20 to 30 minutes before she eats. If you’re doing that, and she’s still going that high, she might be particularly carb sensitive, OR she might be insulin resistant – I’d be surprised if it were the latter given her age, but it’s possible.
Thanks everyone for the replies…it is really scary how varied the advice I get even between calles to my doctors office. They make it sound like we would rather have highs in the 400’s after meals than any lows. Of course its the average they look at which whey want inbetween 100 adn 200.
rpwils & estpeters, I’ll tell you the trick we use with my son, who 3 and was diagnosed at 18 months, to get his a1c down below 8, even though we too still have to give him insulin after he eats. What you do is, as soon as the child starts eating, watch to see how enthused she is about the meal. If she’s really tucking into it, give her half of the insulin she’s going to need for her meal’s total carbs right away, before she finishes eating (if it’s a low-carb meal, say 15 or 20 carbs, you can up that to say 2/3 or 3/4–that is, give her the insulin to cover 10 or 15 of the total grams of carbohydrate). If she’s eating but not with enthusiasm, give her 1/4 of the insulin she’ll need. Then, wait to see how much she finishes, and give her the rest of what she needs to cover what she ate. That way, you can get the insulin started working before her blood sugar gets too high. It will still go up higher than is desirable, but we’re talking mid to high 200s rather than 300s.
Also, is your daughter on a pump or are you using syringes? We used syringes with diluted insulin for the first 10 months and it was clear that numbers in the 300s were going to be the norm rather than otherwise with diluted insulin. That’s one reason we switched over to a pump as soon as we were able to get him on my insurance, which would cover it. If you have the ability to do so, I would recommend it – a pump isn’t any easier than a syringe, in some ways it’s harder, but the improvement in control makes it worthwhile. My son felt a whole lot better when he stopped having the super-high blood sugars.
our endo team said it was virtually impossible to get a very young child down below 8 because you can’t safely dose them in advance - you never know what they’ll eat. I proved them wrong – Eric’s last a1c was 7.9, and the one before that was 7.4 (without excessive lows). I hope to continue proving them wrong!
Pediatric endocrinologists tend to err on the side of caution because they’re so concerned about lows, particularly at night. NO one wants to have a child go into a serious low or even become comatose overnight! But I have heard others say that they think many of them who accept higher BGs are being too cautious, at the expense of the of the child’s long-term health. I’m trying a more aggressive approach myself–being careful to keep him from going low too often, but still trying to stick with BGs below 200. It means I test a lot more often (my ped endo teases me that he’s going to buy stock in Medtronic every time he sees how much I test) but I’m getting good results so I’m going to keep doing it.
Estpeters- you give superb advice. I think many parents have a very casual attitude towards lows in children, especially night time numbers. I find this alarming and dangerous. What you said is very reasonable. As a mom of a type 1 teen who is active, whose A1c is in the 6-7’s range, I give him a hearty bedtime snack, keep him highish at night rather than worry about lows- and also check him.
There is a very good book with lots of useful advice.
Type 1 Diabetes in Children, Adolescents and Young Adults Ragnar Hanas
I know a lot of parents who have found it useful (works well for adults too)
My goal was to attain an 8% from the time I was 6 until I was about 11. Then they dropped my goal to 7%. As a child I was typically actually around a 8.5 to 9.
While I’m now attaining them in the 5s my doc seems to think that anything up to a 7% would be fine.