How did that happen? From super high to super low

Hey all - so last around 8:30 pm my type 1, pumping insulin 8 year old daughter was eating some skittles in the car, and she did bolus for them. And when she got home she bolused a bit more and then went to bed. Around 10:00 pm I checked her blood while she was sleeping and her bg was 28 (504)! ACK! So I checked again to make sure it was true (I always wash her fingers first) and it was still the same, so I let the pump correct her and it gave her 4 units of insulin. But then when I checked her an hour later at 11:00 pm she had dropped to 11 (198) with 3 units still on board!!!

So that started my whole lowering her basal - checking her every 1/2 hour, watching her eventually go low, giving her 2 juice boxes and staying up until 12:45 until her bg was stable again and safe.

But why?? If her bg was really 20 - 4 units should have been perfect… I checked twice, changing fingers, changing lancets everything. We use contour next strips, they are supposed to be super accurate. How can you bg be so high and not need so much insulin???

But really - I should have done what I’ve done before and step correct - where I might give her 2 units, check again in 2 hours and give her more. But I don’t always think of these things, but I should have considering it was night-time and all… but still!!!

When was your daughter diagnosed?

The answer to your “why” might be a surge of endogenous insulin released by the still-alive but “circling the drain” beta cells in your daughter’s pancreas in response to the 504 high BG…

I think your response was careful and rational. With the benefit of hindsight, you could have set the temp basal to “off,” instead of just lowered. Another tactic that could have worked in this situation would have been a correction extended over a few hours but the downside of that is accepting a longer period of hyperglycemia in more usual circumstance. Bottom line, I think you’re just going to have to remain vigilant. Have you considered getting a CGM? You could really use it!

Your daughter’s glucose metabolism is volatile. @rgcainmd’s explanation is plausible.

Also, how much insulin was given in the correction bolus prior to the 10:00 p.m. correction? Maybe the 198 with 3 units still on board resulted from IOB remaining from the pre-10:00 p.m. bedtime correction.

Additionally, depending on how IOB is calculated by any particular brand of pump, your daughter’s pump’s estimate of 3 units of IOB may not have been very accurate. Another thing to consider is that estimates of IOB are, to a great extent, dependent on having an accurate DIA set on your pump.

If, after exploring these possible reasons you still do not have an answer for your “why”, I would consider the fact that T1D does not always play by the rules to be the correct answer.

And I agree with Terry that, all things considered at the time of your decision, your response was a rational one!

Thanks for the vote of confidence - I appreciate it!

Sarah’s had diabetes for 3 years now pumping for two…and I remember when she came out her honeymoon, so I don’t think she has any of her own Beta cells left.

She uses the medtonic pump and her sensitivity is set lower for night-time corrections, but perhaps I should check her settings again and have her nurse check for me too because maybe it needs to be adjusted.

And I didn’t know that you could just suspend the basal - can you on a medtronic? I didn’t want to suspend her pump altogether in case I forgot it was suspended (i was pretty tired) so I just set her basal to 5% for an hour.

I honestly think it was a case of T1D not playing by the rules… sigh. But other than a lack of sleep, I’m glad we came through OK. Sometimes I have to stop myself from going to the place in my head where I think “What would have happened if I hadn’t checked her again after her correction?” But I did and it turned out OK. :slightly_smiling:

When BG’s get into the 500 range, home meters are not very accurate.The reading you got could easily been off by 100+ points or more. I think your idea of bringing it down in two phases might have worked better in this situation. Also, unfortunately, most of us T1’s find we cannot snack on pure sugar. I hope you can find a snack she loves that is a little less potent. Good luck.

Yeah - the skittles were a bad idea… but I don’t typically buy stuff like that. Sarah is a sugar nut though, always has been, but then she always regrets eating it because she feels awful. We have four kids, and I want her to be able to have ‘treats’ occasionally, but once she called a cake a ‘mean cake’ because it looked so good but made her feel so bad. Kinda cute.

i agree with Terry & rgcainmd’s. & for my 16 year old type 1 i find skittles help her out when she is low.

Like Amanda’s daughter, Skittles were my daughter’s “go-to” low blood sugar treatment of choice. Until she got totally sick of them. Now, GlucoLift brand glucose tabs are what she uses to treat lows. Definitely more expensive that Skittles when considering the number of carbs each provides, but the glucose tabs don’t seem to escape their container and make a G_d-awful mess in her diabetes purse like the Skittles did!

eric loves GlucoLift brand glucose tabs. for her it skittles.

google, fat bombs and LC treats. There may be some things your girl will like.

I’d ask too what else was going on. If 830 was after dinner, there’d be IOB plus FOB then too. If dinner was significant, there could be quite a bit of BG activity going on prior to the Skittles, that contributed to what happened later on. I like Skittles as much as the next guy but don’t eat them and bolus, 'just for fun" as, to me, they basically aren’t fun.

One other idea for me would be that if this is a packet of Skittles with nutrition info, perhaps it’s 2 (3? 4?) servings too but if you miss the little itty bitty “2” because, as I am, I just look for “carbs”, that might explain it?

Skittles are, give or take, one carb per Skittle, which is what makes them so convenient for treating lows. This, and the burst of rainbow flavor. Go on, taste the rainbow! But don’t over-treat. And don’t under- or over-bolus. (And be sure to pre-pre-bolus if you’re not eating them to treat a low. Rainbows contain super-fast-acting carbs!) :rainbow: