Balancing Blood Glucose (Sugar)

Checking blood glucose levels is the best way to tell how well your child is balancing her insulin, food, and exercise. To make sure your child’s blood glucose level is not too high or too low, your diabetes team will help find a blood glucose target range. For example, a target range for a toddler might be 6-12mmol/L. If your child’s blood glucose level is 8 mmol/L, it is considered normal because it falls inside the range. If it falls above12mmol/L or below 6mmol/L, you may need to adjust your child’s insulin or food intake.

Setting the blood glucose target range (type 1)

The blood sugar targets change as your child grows and develops. Target ranges are set by your child’s ability and your own ability to understand diabetes, interpret signs and feelings of low blood sugar levels, and act on them. They are worked out with the diabetes team. Everyone on the team should have the same goals.

Blood glucose target ranges (type 1 diabetes)
Age	Characteristic / ability	Acceptable target range (before meals)
Infants / toddlers / preschoolers	cannot sense or tell you the signs and symptoms of low blood sugar reaction eating is not predictable	6-12 mmol/L (110-220 mg/)
School-age children and some young adolescents	eating is more predictable (meal plan) can sense and tell you symptoms of low blood sugar reaction somewhat lacking in judgment depends on others to adjust treatment and plan ahead	4-10 mmol/L (70-180 mg/dL)
Most adolescents and young adults	able to follow a meal plan and eat predictably can recognize and treat low blood sugar reactions understands the concept of balance able to plan ahead	4-8 mmol/L (70-145 mg/dL)
For those on insulin pumps, the range may be: before meals 4-7 /L  (70-125 mg/dL) and after meals below 9 mmol/L (160 mg/dL)

When to check blood glucose

For children and teens who get 2 to 4 insulin injections daily, checking blood glucose levels before each meal and before the bedtime snack – 4 times a day - tells you how the insulin is working. One test cannot tell the whole story. Each test gives a unique and important piece of information. For example, here is what each test tells you:

How to Take a Blood Glucose Test

• The pre-breakfast test tells you how well the dinner or bedtime intermediate-acting insulin worked during the night.

• The pre-lunch tells you how well the fast-acting and intermediate-acting insulin taken at breakfast is working.
• Pre-supper tests tell you how well the fast-acting insulin taken at lunch or the intermediate-acting insulin taken at breakfast is working.
• The pre-bedtime test provides information about the fast-acting insulin taken at supper.

Traditionally, testing before meals has been encouraged. It was felt that these tests provided more useful information than testing after meals, because blood sugar levels are expected to be higher after meals.

 

Blood Sampler and Lancets

However, if insulin is increased based on these higher post meal blood sugar results, there is a risk that the blood sugar may go too low at other times. This is especially true for children and teens who are on conventional treatment – that is, insulin injections 2-3 times each day.

Recent information suggests that the peak sugar levels after meals -- called post-prandial hyperglycemia -- are also important contributors to long-term complications. Therefore, young people who are on a routine of multiple injections of fast-acting insulin with meals or who are on insulin pump therapy will benefit from some blood sugar checks 2 hours after eating.

Glucose testing 4 times a day is ideal but may be a challenge. For example, a lunchtime check in young children in daycare or school may be difficult, and staff support will be needed. You will need to negotiate this with the staff at your child’s school. Older school-age children may also find lunchtime tests inconvenient, but they should be encouraged to do them. Once in a while, a check in the middle of the night helps detect those at risk for late-night lows.

Sometimes the blood sugar may be routinely outside the target range (too low or too high). In this case, at least 4 daily checks are needed to determine the correct insulin dose adjustment.

When to do extra checking

Glucose Meters

There are many brands of glucose meters available.

Sometimes blood sugar should be checked apart from the routine. Here are some situations where you should do extra testing:

• before, during, and after a lot of exercise such as dancing or soccer practice
• at times of stress
• if symptoms of low blood sugar are present
• every 4 hours during an illness
• at other times prescribed by the diabetes team, or when trying to problem-solve or gather information about the impact of a certain food or activity

Children and teens using insulin pumps need to have more frequent testing, to get the most out of their pumps.

It’s been said that managing diabetes is a little like performing a complicated juggling act. Sometimes the ball drops. No matter how hard you try, it’s impossible to keep the blood sugar in target range all of the time. Sometimes it will be high, other times low.  Often there is no way of explaining the results. Extremes can result in the following:

• Hypoglycemia, or low blood sugar. This is often referred to as an insulin reaction.
• Diabetic ketoacidosis (DKA). This is the result of a severe shortage of insulin.
• Hyperglycemia, or high blood sugar.
• Sick days. They can lead to either hypoglycemia or DKA when not handled properly.