Hello Docs, my 9-yr old son was just diagnosed with Type 1 diabetes on Friday, which of course triggers the tsunami of boot camp-like information delivery for the parents about all the ways one must manage it going forward. Thankfully I am already well-versed in weighing food, counting calories (and protein), etc…and now must add carbs (something I never tracked for myself) to the mix for my son. At his age he is obviously not doing intense barbell training, but he is a kid…and so rides his bike, jumps around, and climbs everything as 9-year olds tend to do…we were told that “high (in terms of blood sugar) is bad long-term, but low is bad short-term,” so my wife and I are already fearful of the dreaded below 70 reading…I know all cases are different, but in general, should we worry about his activity level (say a 1 hour bike ride) leading to hypoglycemia?..and also, can you recommend any glucose monitors, insulin pumps or closed loop systems as the poor little guy is currently being subjected to 5 finger pokes and 4-6 shots of insulin daily (1 long acting and 4-5 of the rapid depending on meals). Many thanks and I am sad to be posted this vs a question about breaking my every-present plateau on the press. 
Hi there,
Sorry to hear about this challenging diagnosis. Fortunately there have been lots of advancements in the management of T1D that will help your son live a more “normal” life, or a least as normal as is possible with the condition. I would also encourage you to seek out the family support groups where you will be able to learn a lot and get advice from those in similar situations.
I know all cases are different, but in general, should we worry about his activity level (say a 1 hour bike ride) leading to hypoglycemia?
As you said, everyone is a bit different and this depends on a number of factors that you / he will learn to monitor and modify over time. It would be wise to keep some simple carb sources on hand during such bike rides (or most of the time, in general) and see how he does.
…and also, can you recommend any glucose monitors, insulin pumps or closed loop systems as the poor little guy is currently being subjected to 5 finger pokes and 4-6 shots of insulin daily (1 long acting and 4-5 of the rapid depending on meals).
This is a great discussion to broach with your/his endocrinologist - I think there are likely to be options that will substantially improve his quality of life with T1D.
As a type 1 diabetic myself perhaps my experience may be helpful. Obviously this is my experience, and so anecdotal, so it should be taken with a grain of salt and all questions specific to your son should be brought up with their endocrinologist.
I was diagnosed at 15 and management of the disease was left largely in my hands so my experience here will be different than yours. I was taking nph 2x daily and humulin R with meals, this combo was generally fine but I had anxiety over lows so let my blood sugars, and consequently my A1C, tend to the higher side. The issue with this short term is I had to take insulin correction factors to bring my blood sugar levels down more regularly and if I failed to account for this around meal time or activities I would experience severe lows and even hypoglycemic convulsions (is seizure the right word here docs?). This occured a total of 3 or 4 times over 7ish years; this may sound like it was a rare occurence but I could have potentially died if I didn’t receive immediate medical attention each time. This led to me testing my BSL 12-20 times a day… as I live in Canada it was covered by healthcare but they eventually implemented a test strip limit so it became quite cost prohibitive.
At 22ish I finally got a pump and it was a god send compared to the ol’ insulin needles but it was also drastically easier to put myself in a risky situation as my diabetes management became entirely dependent upon a continual supply of the rapid acting humalog. I did not experience severe lows due to my endless testing, but my fingers were a mess and the strips became personally costly. I did the math (after several years at the age of 30ish) and it made sense for me to switch to a wireless glucose monitoring system. At the time nothing was covered, but the Freestyle Libre was the cheapest so I went ahead with that. It does not communicate with my medtronic pump but I can scan it and get readings every minute if so desired. Naturally my test strip usage is now extremely low but it is important to still finger test during periods of low BSL symptoms (and/or rapid BSL changes). More importantly, being able to get readings as often as I like led to far greater control of my diabetes and my A1C has been below the canadian therapeutic target of 7.0 ever since I started.
The pump companies and sensor companies must realize the costs of all this are pretty gross so they do seem to have programs to help out low income individuals such as myself. If you can get a sensor+pump combo that can communicate it can automatically adjust basal insulin rates (and stop them all together) during lows! Just be aware the adhesives on the sensors is, in my experience, absolute garbage so you should look at using skin-tac and tegaderm with the sensors. If you have insurance you could look into their wireless glucose monitoring sensor and pump coverage and take that information to the endocrinologist your next visit to get more clarity on a treatment plan moving forward.
Please let your son know the world is still his to enjoy, and that he can still chase his dreams wherever they may take him. He might just need your watchful eye for a bit but this stuff will all become second nature to you all.
edit to specifically address your concern re: exercise and lows: I would always, always, always ask my friends/family if we had any planned walks/sports planned after eating so I could adjust my meal bolus dose of rapid acting insulin. Rapid acting insulin (humulin R, humalog) + exercise will cause blood sugars to crash if the exercise is not accounted for in insulin dosage. As you pointed out a low is more dangerous short term than a high, so if there is any possibility of prolonged physical activity (or any activity in my opinion) I always take approximately half my calculated bolus amount. My blood sugar goes high but the physical activity will bring it down a little later… and if the activity plans fall through? I take a correction factor to bring the BSL down to an appropriate level after the fact. Small tip I learned the hard way-- DO NOT STACK CORRECTION FACTOR DOSES!! Insulin takes time to absorb, circulate, and trigger uptake of sugar from our blood so it takes time for blood sugars to drop. Ask the endocrinologist about active time of the prescribed rapid acting insulin to give you a sense of when you may need to redose insulin.
Talk about this stuff as you are going through the motions so your son learns it passively, he will begin to pick it up and soon you can let him guide you through his diabetes management by asking “ok, what next?”.
Thank you so much for the quick response. A tough road awaits for sure, but we will adapt. Our son is already taking it in stride while it’s much more difficult for mom and dad.
All the best.
@romanxgiordano See the post above yours