I have to tell you, there is a huge difference between an acute hypo requiring immediate assistance by emergency medical personnel and a hypo that can and should be treated at home. No person with diabetes, let alone a parent of a child, should wait until they have an acute hypo before treating. Acute hypos involve a whole set of medical protocols and practices and have a much more personal and severe impact on you. And with a child involved it is even more important to stay on top of things.
You should consult your endo for individual targets, but typically a target lower range of 70 mg/dl will be given. Blood sugars below this target are considered hypos and should be treated. Let me repeat, they are considered hypos and should be treated. And you treat to the meter even if symptoms are not felt. Nobody should wait around until they suffer an acute hypo before treating. The whole point of treating below 70 mg/dl is so that you âdonâtâ suffer an acute hypo and put your life in danger.
The OP didnât say he was concerned about the 70-80 level; the OP said he was having trouble keeping his son in the 80s, that even while eating without bolusing, eating high-carb foods, and suspending the pump he was only able to get his sonâs blood sugar up to the 80s before it would begin to drop again.
Being in the 60s and 70s may be safe for someone without diabetes or for someone with diabetes whose blood sugar is stable, but itâs definitely not a safe place to be for someone with Type 1 who is experiencing instability in their blood sugar (which the OPâs son is).
Thanks for the replies! I have definitely noticed that âlowâ is interpreted differently by different people. It is likely not the same for everyone because not everyone is the same. I have often wondered why my sonâs target BG is so much higher than what I see from others online.
UPDATE: I am able to get my sonâs BG to rise closer to target nowâalthough we had a bit of a scare. He had spiked after his dinner meal last night, and we gave a partial bolusâbut then he fell dramatically all of a sudden. It seems as though all of those finely tuned calculations we have faithfully used for the past year are out the windowâand now we have to start over.
Thank you everybody for your support and information. I will keep the micro glucagon option in my back pocket should the need arise.
They keep kids higher than adults, is this similar to his target that the endo set?
people use hypo for what their endo means as a low and they have become interchangeable. your endo has kids hypo/low set higher
Exactly⌠70 shooting down or even 120 shooting down is a bad hypo coming on⌠just treat it as soon as you have the crashing feeling⌠that is what I do most of the time unless Iâm really high ,but even then if Iâm crashing with lots of iob I treat it as needed. Not a good idea to get to the 40âs and below for anyone.
These articles are interesting BUT you do need to read them carefully and understand the context.
The second link, the paper by Morales et al is the American Journal of Medicine which is a highly respected peer-reviewed journal. The article is fully cited to a Reference list of other peer-reviewed publications.
Table 1 in the article provides a number of conventional definitions of hypoglycaemia. It is correct that as suggested by Seaquist et al the limit of 70 mg/dl (3.9 mmol/L) is one of convention and is based on historic data regarding serum glucose levels in non-diabetic patients and is intended as an alert level. However Table 1 uses this definition and one of the categories is âProbable symptomatic hypoglycaemiaâ defined as Typical symptoms responding to self-treatment but not confirmed by biochemical documentation but presumably caused by plasma glucose <70 mg/dL. This table also includes a definition of Pseudohypoglycemia where symptoms are present but serum glucose is >70 mg/dl.
The other two links are for articles in non-peer reviewed publications (Medscape and the Merck Manuals). The contentious statement is the one in the article by Smeeks et al in Medscape which suggest definitions of hypglycemia at 50 mg/dl or less. This is a short article reviewing data on individuals presenting to the Emergency Department with hypoglycaemia (which Smeeks et al define as serum glucose <60 mg/dl for the purposes of their article). No source for this number is cited and it appears to be an arbitrary cut off limit imposed by the authors for their study. The lower limits (<50 or <40n for kids) is another arbitrary cut-off defined by the authors for the purposes of their study which is titled Acute Hypoglycemia . I assume that they are intended to identify levels that they consider Acute Hypoglycemia and by implication levels that are potentially dangerous!
It is risky to suggest that a ârealâ hypo only occurs at under 50 (and for kids under 40). These numbers are uncited and arbitrary. Serum glucose levels in the range 40-70 may not be by definition regarded as acute hypoglycaemia but by any normally accepted definition levels below 60 would certainly be regarded as overt hypoglycaemia, potentially symptomatic, and requiring treatment.
I was saying he should give glucose when the child was 80,
I was the only poster that suggested kids are set at a higher low.than 70
I gave an approx number of 80. I then got the ADA link and it is suggested 90.
I was originally trying to reassure the OP that although 70-80 low and it should be treated in the circumstancesâŚdonât panic as there is a safety margin and a higher safety margin is given to children.
If anyone read my posts, there is no way anyone could come to the conclusion I was in any way saying wait till you are under 50/40 before treating. I take offense by those suggesting such.
If anyone have issues with the medical communities insulin induced hypo levels, I suggest they take it up with them. Nor will I give a medical definition of chronic and acute, but they are timelines
I never realized the lasting effect a stomach bug would have on my 4 year old. He is eating normally now, but still not spiking. For example, I took him to IHOP for waffles and regular syrup. I only bolused 0.2 units (normally would be several units). There was no spike, and he ended up going low. We only see very gradual rising after meals, but no spikes. We are running on 50% basal from normal and still have to shut it completely off at times. Our Endo has suggested micro glucagonâwhich is interesting because I only learned about that until recently. For now, he is eating/drinking regular soda, candy and pastriesâas we are still fighting the ketones.
For two weeks after my daughter recovered from her first GI bug after diagnosis, which was before she began pumping, I had to reduce her basal insulin (Lantus) by quite a bit, and she needed no fast-acting insulin (Humalog) at all. It was almost as if she no longer had T1D. But I knew this was only temporary.
This may also give some help to you, âŚas always put everything by your endo
A workbook (the certificate ran out but the site is safe)
it seems the tummy bug has stirred up his âhoneymoon periodâ and his pancreas is working better.
I would cut back the basal some more if you need to turn it off. and contact endo about doing a basal check, what normally happens is you do the test and submit the numbers and the endo adjusts the hourly rate, which can vary during the day⌠https://mysugr.com/basal-rate-testing/
I wouldnât give high carb meals at this time. just keep cutting both the basal and sugar/starch carbs till you get within range. I would increase the moderate veggi and salad carbs with more proteins and fats. this may give a slower digestion and a more stable BG without the rollercoaster highs and lows, which the basal and sugar drinks may be doing.
for next month when things have settled down, to discuss with the endo.
you may find the diet you had or somewhere in the middle suits you and you child⌠but I would like to show you another side, where kids are on low carb that have very stable BG in non-diabetic range most of the time
It is a group on FB you need to join to get full access other than the front page.with kids
My understanding is that itâs not the honeymoon phase (especially if the child has been diagnosed for several years) but rather that the stomach takes a while to fully recover after an illness so food isnât being absorbed properly for several weeks.
youâre rightâŚI was thinking it gave the immune system something to attack besides the pancreas and allowed whatâs left to function better and was part of the basal being too high
I think you are right, that makes more sense that the food isnât being digested.
Jen, you hit the nail on the head. Itâs all about the gut being slow to recover its ability to absorb carbs. Thatâs the reason why kids with Type 1 who have erratic episodes (one to several days or more in length) of going low for no identifiable reason are tested for Celiac.
I think that, rather than getting âdistractedâ the immune system would actually intensify its attack against the beta cells if someone was also sick. The immune system makes antibodies that recognize the beta cells and related thingsâŚthose antibodies wouldnât just go off and do something else because they are made specifically to recognize and fit the beta cells so would be useless against something else like a virus. Plus, if the body is under stress, the immune system may freak out and feel like itâs âlosing the battleâ against the beta cells (even though the other illness is completely unrelated) and try to fight even harder. I think this is maybe why so many people feel they got Type 1 after some sort of stress or illness. Even though the autoimmune attack takes years, those things probably intensified the autoimmune attack and shut down their last few beta cells, at least until the stress is over and the honeymoon begins⌠(I am no doctor, this is all just pure speculation, but based on what I know about the immune system and autoimmune diseases and allergies and my own experience, illness or stress definitely makes things worse in those areas, not better.)
I think you are right @Jen. My son had gotten really sick a number of weeks before diagnosis.
I actually work in a serology lab testing animal diseases. In the lab we look for the presence of antibodies that indicate an immune response to a particular disease. One thing that I have personally noticed over the years is that an animal does not manufacture just one specific kind of antibody in response to an antigenâbut actually several different kinds. Not a fine-tuned response to a specific antigen. It could be that the beta cells are just similar enough to be collateral damage⌠a theory anyway.
My suspicion is that the gut flora that was predictably metabolizing food was disrupted. I donât know if it was the body not absorbing foodâor if the food wasnât broken down to be absorbed.
In any case. My son is doing much better nowâand I am seeing rises in BG after meals (although still not the sharp spikes as was the case before) and ketones are small.
Yes, I have heard the theory of the immune system getting confused between a virus that âlooks similarâ to beta cells before. Who knows what really triggers itâIâm sure it may even be different for everyone.
