When my son was diagnosed in November, we were told to correct a low of 70 or below with 15 carbs of juice, wait 10-15 minutes to confirm that his bg goes over 70, then give him 15 carbs of food (like crackers and p.b. or cheese).
These rules don't seem to apply anymore. Tonight, he had a low of 66, so he drank 14 carbs of juice, tested 15 minutes later and was 140. We gave him 5-6 carbs (crackers and p.b.). Then 2 1/2 hours later at 12:30 a.m. I checked him and he was 213, so I had to give him a correction. Nighttime corrections make me nervous, so now, I'm waiting until 2:20 to check him again to make sure that he doesn't go too low. Was it necessary to give him the complex carbs?
Could I have just given him the juice and not the crackers? I thought that we were told that we had to give him food (complex carbs) so that he wouldn't dip back down again.
Is there something else that I could have given him?
Maybe non-fat milk would have been better and then no other food...Or glucose tablets. We have never used these before.
Any thoughts? I know everyone is different. I'm just looking for ideas on how to treat his next low so that we don't overcorrect it and then end up having to treat a high. Yikes!
He is currently using a Ping pump. He's 12 years old and I think he is still in the honeymoon stages. His daily basal is 7 1/2 units and his ratio is 1:15 carbs. His correction scale is 1:50.
I'm the opposite of Sally and would just use the juice and skip the crackers. I think that peanut butter crackers are on all of the lists because protein can be recommended. I think milk may be better since it has the protein and moderate amount of carbs.
If I run lower I will have cheese or maybe treat the low with milk but, while I enjoy eating complex carbs when I'm low (munchies), they often will push my BG up. If I eat carbs as can happen, I'll estimate where my BG is going to be from the quick carbs and bolus for the complex carbs I eat. I also like to wait 20-30 minutes before I check. 66 isn't a huge "red alert" [blue alert maybe?] number for me either. I would look closely at that time to see where the shot was and maybe had 5-10G if the last shot was 3-4 hours prior. I use a mix of jelly beans and smarties for lows a lot and will just have 3-4 if my BG tails off without a lot of IOB
I personally won't eat any complex carbs unless I have taken insulin. For example if I eat lunch and go low I'll eat complex carbs because I've still got the bolus working, but if I haven't eaten and I go low for no reason I just take juice or the sugar tabs. But I'm an adult. Good luck to you and your son
The standard advice to treat lows is actually an overtreatment for most situations. A child may rise 10 mg/dl for each gram of carb, so 15 g of carbs may raise your blood sugar 150 mg/dl. If you just have a fasting blood sugar that drifted down to 66 mg/dl, raising your blood sugar to 216 mg/dl by treating with 15 g of carbs is overtreating.
That being said, it is important to make informed decisions about treatment. You don't just treat a blood sugar reading, you need to consider how much insulin is still on board and how food is still undigested. This is particularly important when treating a post meal low and a low that occurs during a fasted state.
My strategy is to treat to target. If I have a low, I want to quickly bring my blood sugar to a target of 70-110 mg/dl. I don't want to target 200 mg/dl. So with a blood sugar of 66 mg/dl in a fasted state, all I need is 1 g of carbs. I use pure glucose, actually sweet tarts and smarties (just like glucose tabs), where each little tab of smarties is 0.4 g of carbs and each little sweet tart is 2 g of carbs. If you use juice or table sugar or something containing significant fructose, you will get a less effective and slower correction.
While you might not be as conservative as me. In your case, you already overtreated with the juice. The juice would likely take another 15-30 to full absorb and he was already at 140 mg/dl. And then you gave him more. If this was an after dinner high, I would suggest treating with glucose to fix the low and then eating some protein to buffer against any further lows. In this case, if it was 4 hours after a meal, he likely didn't have any real insulin or food on board and you could have treated much more conservatively.
My dd is 14. We would’ve skipped the snack. For a 66, unless she was particularly active earlier, we would give half the juice or a half cup of whole milk. Whole milk seems to have the perfect combination of carbs, protein & fat to bring her up & keep her from dropping again. The Rule of 15 is a good conservative plan for low treatment, but you’ll find that the amount of carbs needed will vary depending on what caused the drop, & the time it takes the carbs to fully absorb may be much longer than 15 minutes.
With such small basal amounts, it sounds as though he’s still in the honeymoon. Honeymoon is defined as 0.5 units or less per kg of body weight.
You are better off with the tabs, since over time food intake will usually outstrip the low. I am living proof. Anyway, that is another story. But if you can live on the tabs you have more control and less over correction.
Yes eating is so much more satisfying when you are low. Therein lies the issue, it is so much more satisfying that running to food over time will usually lead to over correction.
I correct with Level, no matter how low I am. It is exactly 15 carbs and hits my blood sugar immediately. That way when I stop having the munchies I can correct sensibly (with maybe peanuts or a few crackers).
First, it's all a learning process so don't feel like you have to get it "right" the first time.
Second, it's all a learning process so don't feel like just because you got it "right" the first time, you're going to get it right all he other times after that.
Third, it's all a learning process so don't feel like it's going to just be a simple as "right" or "wrong".
That being said, I'll echo Brian and say that the idea is to correct back to a target range. My target range to correct back to is between 80 and 110 depending on the time of day/night and what I'm doing. It could be as high as 140 it I'm getting ready to hit the gym or, otoh, I will not even bother correcting a 66 if I'm getting close to a meal. What I definitely do not want to do is to put myself on a roller coaster where I'm over-correcting with either a carb source or insulin.
Determine what your target range is first.
I'll echo Brian and say that getting back to your target range depends on a lot of other factors like activity level at the time, is it a premeal or post meal BG, how long before or after a meal is the low BG occurring, is there IOB, carb ratio at the time of the low, etc etc etc.
All those determine how I'll treat a low and what I'll treat with.
What that means is it will never be a simple as correcting with 15 grams of this or that, or it might be a simple of correcting with 15 grams of this or that, but you have to take everything else into consideration before you correct.
I know that (somewhat) different rules apply to kids but I would have taken 1 glucose tab (4 carbs) for a 66 or 2 glucose tabs if I tested low in the middle of the night.
I would be more conservative in treating a low especially when your son doesn't have too much insulin on board and his basals appear to be correctly set. The second snack of more complex carbs might make sense if your son has significant insulin on board. I would rather check every hour to make sure things are leveling out and eat a little more if it appears the original snack wasn't sufficient.
i agree with this, i'd probably do one glucose tab or some jelly beans. it depends on when the low is, if I still have bolus on board, being really active. I rarely do 15 grams of carbs unless I still have bolus on board, working out, etc...and am really low and dropping quicker. Maybe I'd have done 2 glucose - 8 carbs. It's trial and error. I never use snacks for lows, only glucose tabs or juice if really low.
Thank you for the advice. I didn't know that it was okay to treat a low without a fast acting sugar and a complex carb. The information you all provided will really help us in treating lows. I really didn't want to give him the complext carb after he was already at 140, but I thought I had to.
It looks like I should have provided more information. The low was about two hours after dinner (at his bedtime check). He didn't feel low and he didn't have much iob left. We were surprised that he was low. Our target number for the daytime is 110 plus or minus 20.
We were originally told to have his bedtime number at least 130, however, when he was switched to the pump, the CDE didn't seem to have any problems with him being being in the 90s at bedtime. Then he had a nightime low out of the blue, so we are still trying to determine what number would be a safe nighttime number. I think going to bed at 110-120 would be good. I just need to figure out how to get him to 110-120 before bed. He's usually on the lower end. I will try adding smarties and seeing how that goes, then I will change his 6 p.m. basal to see if I can make his bedtime number in range w/out having to treat lows.
I'm wondering what other 12 year olds bedtime number goal is. I'll ask on the parents forum too.
You're doing great and great questions, too. Agreed, night time corrections make me nervous too. Glucose tab is all carbs. The CDE's always say treat a low with PB cracker or protein along with glucose tabs or eat a snack before bed (may be different for a kids??). One CDE told me to eat 15 grams of carbs before bed...HUH, i'm a type 1 diabetic, i can't eat 15 grams of carbs w/out insuln..hello, I'm a type 1 diabetic and why would I eat 15 grams of carbs without insulin before bed? So, I never do the snack thing either because I end up just sky high and then the high - low roller coaster. I'm surprised to hear CDE saying 90 at bed, on pump, was OK. How long on pump? If he's stable that is OK, but if not, yeah..shoot for something a bit higher. Are you doing night time checks, do you have a CGM...if not, they can do a trial CGM on him to see what's happening in the middle of the night. If he's going to bed 2 hours after dinner (I think that's what you said) maybe you could move his dinner time up a bit to make sure all bolus is done before bedtime, just a thought? Hang in there. :)
OH, are you sure his ISF (correction factor) is right, that seems a bit high for someone honeymooning and pumping 7 basal. We had mine at 1:50 it was too much and I'm going to change it to 1:70 and I pump about 11 units basal (maybe a bit less).
While I usually aim for and correct to 95 at bedtime, I'm also willing to accept overnight lows on occassion which is probably something that you don't want for your son. 110-120 looks like a good target.
If your son likes almonds, you might include a handful as a bedtime snack. They are almost a free food in the short run and provide a little additional stability over the long haul.
For a 65 with no insulin on board, since I know one gram raises her blood sugar five points, I would give 10 to 15 grams total. Skim milk works fast. Maybe half cup skim milk three or four ritz or saltines with cheese stick. Or I particularly like giving yogurt, the GoGurts are 10 grams, regular yogurt 15. I never give 30 grams of carbs unless she has been exercising or has IOB. For a 50 I would give juice but only ten grams. Then follow once sugar comes up with 8 or even 10 grams of whole milk, yogurt, crackers and PB or cheese, etc. If you overtreat you will then have to give insulin again or he will be high all night. Sunflower seeds don't really count too much carb wise as they have a lot of fiber. You can always throw some of these in if you don't want to give too many carbs.
The standard advice of 15 grams for anything below 70 is absolutely terrible guidance. If I ate 15 grams at 65 I’d be 200 half an hour later. My advice woul be to forget you ever heard that guidance and focus on what works for your child. Test at different intervals after eating one glucose tab or piece of hard candy and you’ll soon have a pretty good feel for what to expect with smaller correction carbs
I don't know if this will help but my doctors said that if it is within the four hours after a meal,you should take 30g carbs (juice plus cracker/pb) and if it is out of this range, try 15g.(just juice) Of course all this depends what activity you are doing, where you are starting from etc. But this seems to be a logical approach even if the quantity of carbs might not be quite right.
Personally, I like glucose tablets because they are quick and you can limit them.
good luck! most of us get it from trial and error.
Please ignore this reply. I didn't mean trial and error, I meant experimenting. The site didn't accept my correction. The numbers of carbs my dr suggest does seem quite a lot.
[if you miss the 15 minute window to "edit" your comments, you can mouse over the upper right corner of your message and delete it by selecting the faint "x" that's sort of hidden/ lurking there.] I don't do it that much but, every now and then I type something way off on my phone and unable to edit within 15 minutes so I'll copy and delete or adjust the post.
Readings are not veinous, (not from a vein) which means by definition they are NOT real time, not accurate.
You would get a different reading if we could get the blood from a vein, but that would be messy and unpleasant multiple times a day. When we get a reading, which anybody feels we need to treat, our body has already started a sugar dump (from the live) to "protect" us, keep us alive.
His spike-high is NOT from the crackers w/ cheese, not from the peanut butter... its because you caught the low, but his body was already catching it too, it was just beginning.
Had he gone lower, the spike would be higher... When you add in the honeymoon effect, you really should not make yourself crazy with a 212 spike, its nothing to speak of.
