What BG range is 'good control' for 4 year old

[Addiesmom]

Hello, my four year old daughter was diagnosed with Type I a little over a year ago. She has been on the pump for a year using Novalog. She is seemingly healthy and happy. She's very compliant with all of the routines for her care. However, she does still have high blood sugar readings--sometimes at night in the 300 or even 400 range. She still has readings in the 50s or 60s, as well. A friend mentioned this meant she was "brittle"--I know that term is vague, but I'm wondering what other parents experience? On the pump, should she typically be at or near her target (140)--or are these big swings typical? Obviously we treat the highs and lows, but I'm wondering if her diabetes is more "severe" than others. If so should we be more aggressive controlling her diet? We allow her to eat almost all "normal" four year old foods, balance out carbs with protein and fat, and cover carbs with insulin. Her last A1C had gone up some due to highs at night, but we adjusted basals. Last reading was about 8%.Thanks for any insight--

[JDRF-Team-wak]

I am not physician, but a mom of a type one diabetic.  My daughter has been diagnosed as a type one for almost 6 years.  For the most part we are in good control but occasionally we do have “brittle days".   What that means is that you are not in control for those, days; she is either running high or low or all over the place.  Most diabetics have them. even on the pump we have brittle days. It does not mean that diabetes is more severe.    we treat are daughter with a normal  diet, but when we notice that she is becoming brittle, we pull back and give her a more strict diet just till we are  back where we ant to be.   This usually works for us.  I would suggest talking to your doctor or nutritionist if this is becoming a regular occurrence.

[JDRF Team SGG]

I agree with the previous posting... good advice! Occaional "slips" are pretty normal, but what we don't want to see in children or adults is wild swings becoming the norm. The child will feel bad and her body is starving for the energy that comes from properly processed carbs when that happens. If several days of wild swings are happening, then it probably is time to "tighten up" some for a while to try to normalize and to protect her. But don't stress over the occasional goof -- we are not computers, and human bodies react to all sorts of stimuli. It really is impossible to keep a young child's glucose at perfect levels all the time.

As for worse diabetes, I truly don't think that there is any such thing in the type 1. Basically, our pancreas cells just don't produce insulin. There is no better or worse to it. You may have to adjust her diet a little, maybe adding a little more routine and structure to what she eats and when she eats in order for her glucose levels to become more predictable.

I have been a type 1 for 37 years, and I was raised back in the old days when freedom to eat what we wanted to and add insulin to adjust was not the norm. The old method of maintaining glucose control was dependent on set doses of insulin that didn't change and set-in-stone diet (the timing and the carbs eaten for each meal were not ever changed). Now, we have come a long way since then, and I am grateful for the freedom we now enjoy in our lives, but when glucose levels are not stable, sometimes it isn't a bad idea to go back to the more set-in-stone routines for a while. I tend to do this by habit after a childhood of eating this way, and I find that it does keep my glucose levels nearly perfect all the time.

The reason is that different foods are digested and processed by the body at different rates, and of course there are sometimes "hidden" carbs in foods we eat. Those factors can make matching insulin absorption to food digestion a real tightrope walk. I find that when I need to tighten up control, I lose the flexibility in my diet for a few days, and also it seems to help me to avoid high-fat foods at that time, for they digest so slowly that my insulin works before the food digests and high levels can happen later on after the insulin is gone. Pizza and french fries are prime examples of foods that do this to me... I have learned that for ME, if I eat those foods, I need a small amount of insulin at mealtime followed by the rest of my normal dose several hours later, for the digestion time is really slow for those foods. I do better with lower-fat meals so that the digestion time can be predicted and insulin absorption matches it well.

You have years to try different things and work out routines that "work" when your daughter needs a little extra help. Keep up the good work, and we wish her a long and healthy life.

[GenX Diabetic]

I have been diabetic since I was 4 and one of the things I have had to adjust for the entire time is seasonal changes. Activity level changes, body fat content starts going up a bit, which changes the absorption rate of whatever meds are used, etc. This time of year I still have to adjust my meds, and forget about Thanksgiving! Keep the glucometer handy. Kids are growing also, which makes regulation even more challenging! I, personally, start an incremental change starting around Sept 15. And start going to the gym! Take care.

[Addiesmom]

Thank you very much for these helpful ideas. I think perhaps we will ratchet down on the diet and see if we can get better control that way. It was helpful to remember the not-so-old days when there was no pump and the diet had to be "written in stone." So I'll stay grateful for our flexibility, but not abuse it, either....Stay well all--Kathryn