Most children with CHI will require their blood glucose to be monitored to ensure the child is not going hypoglycaemic. The individual's blood glucose monitoring requirements and emergency hypoglycaemic protocol should be detailed in an individual care plan from their specialist team and it is vital that this is adhered to.
Blood glucose monitoring helps to detect patterns too such as illness, stress, poor feeding, hormonal changes etc. all which can influence blood glucose readings and it’s important to be aware of this.
A common method is by using a blood glucose monitor and lancing device. This gives a snapshot of what the blood glucose level is at that moment in time. Many children with CHI become used to this method as it becomes a part of their daily routine although for some it can be stressful.
More recently, we have seen the adoption of monitoring blood glucose with a CGM (Continuous Glucose Monitor), or Flash monitor. These are small devices worn just below the skin that measure blood glucose continually throughout the day and night. CGM devices alert you to hypoglycaemic episodes via the receiver, whilst Flash monitors require passive measurement. There is a slight time delay (usually up to 15 minutes) with this method so a finger-prick test with a lancing device may also be required.
Generally, most healthy individuals have blood glucose levels between 4-7 mmol/litre. This is known as Normoglycaemia.
It has been agreed nationally amongst all the tertiary children’s hospitals along with hyperinsulinism specialist centres to consider hypoglycaemia as under 3.5mmol/l (63mg/dl). However, this may vary depending on your own child’s circumstances so please follow the care plan given by your medical team.
In children with hyperinsulinism ketones are not being produced therefore the alternative fuel for the brain is not available. Hyperinsulinism children tend to drop very quickly which is why specialist centres will advise you to treat any blood glucose levels below 3.5 mmol/l.
mmol/L vs mg/dl
In the US and many other countries you may see blood glucose levels in mg/dl. You can multiply the value in mmol/l by 18 to get the value in mg/dl. However here is a basic conversion chart. We have highlighted the blood sugar levels:
- Green = normal levels
- Amber = may be giving concern - follow instructions from doctor
- Red = severe levels - urgent treatment required - follow instructions from doctor
| mmol/l | mg/dl |
|---|---|
| UK, Canada, Australia, China | U.S, France, Japan, Israel, India |
| 1 | 18 |
| 2 | 36 |
| 3 | 54 |
| 3.5 | 63 |
| 4 | 72 |
| 5 | 90 |
| 6 | 108 |
| 7 | 126 |
| 8 | 144 |
| 9 | 162 |
| 10 | 180 |
Please note that the higher numbers in this table are not appropriate reference for diabetic children or those who may be becoming diabetic after near-total pancreatectomy. Please contact your clinician if your child is regularly having blood glucose readings above 10mmol/l or you are concerned that they may be becoming diabetic.
