Reevaluating low treatment protocol

Ugh, so lately my son has been going low constantly. Technically our stats look okay (less than 4% below 70, 9% below 80), but it hides the fact that a) there have been some days where 50% of his calories are coming from low treatments and b) even if he spends almost the same percentage time total low, his lows seem to be drifting deeper into the red zone :frowning:

I know we need to rejigger his settings, but I also think part of the problem is his treatment when low. He gets a 4 gram snack and that raises him typically 30 points, and then he drops back down again. So we may successfully avert one low at school, only to have a second one about 45 minutes later.

So how much do you think your low carb treatment raise you? I’m thinking his needs to be upped to 6g or even 8 g. He is growing as well – every few weeks he just seems to be a lot taller so maybe that’s part of it.

I know one option is to change his basal rates. But it really seems like he has these weird periods where technically, he has no leftover meal IOB, is coasting along fairly flat on his basal rate, and then all of a sudden just starts plunging for no apparent reason. It’s like he has 1-hour periods where he has no need for insulin or is highly insulin sensitive. I’m just not sure it makes sense to have 1-hour basal segments.

Having all these lows makes me feel like I’m failing him as a parent :frowning: I know he feels awful when they happen.

I would imagine growing would make your insulin needs go up, perhaps even his nutritional needs. I’d talk to your GP (or Internist) AND your Endo about both of those things and just over-correct a little bit until you find the right amount. You’re working at a disadvantage, because I often have a general idea of how much to treat. However, I also often adjust it knowing other factors, like have I just been doing a lot of activity?–or did I eat something a very short time ago that’s going to hit me soon?

The immediate problem is the low, but I also need to either bolster my BG with a snack or a meal (or not). Figuring all of this out is both an art and a science. I would definitely up the treatment AND make sure that you have a snack after that will both raise his BG and steady out the amount of glucose he’s getting. (A snack with carbs AND protein is what I mean). It’s not easy after a low to have the courage to have a snack that’s substantial enough that it will require a bit of insulin. (But only a bit).

For recurrent lows, I’ve been somewhat successful with a one-two punch. Enough fast acting to bring me up sand some slower acting to sustain. For example, I’ve found glucose tabs followed by a kind bar to be a good combination.

Agreed re: the short-acting followed by longer acting snack. If I’ve had another low already recently, that becomes important, I think because my liver gets depleted (from helping out w previous lows), so it becomes less helpful for subsequent ones as well as less of a factor generally, potentially shifting my basal into being a bit too high. (Same thing is true if I have a low with alcohol in my system—always follow the initial fast-acting carbs with a snack.)

If you’re noticing a constant pattern, I’d be more inclined to be asking what is causing these lows rather than why is the treatment not working?

Like @Timbeak48 said, the way I treat my lows is usually approached based on external factors. Did I just exercise, do I have any insulin on board?

Perhaps try as others have suggested, the initial bit of glucose to immediately get the blood glucose up, then something smaller to keep it stable. It’s hard to say what might work for your son, but for me I can find if I’m worried about dropping after correcting the low, even if it comes back into range, I’ll often have my correction glucose, usually 4 grams, and then a handful of nuts or something like that.

Hi @Donman90, yes the first priority is to reduce the incidence of frequent lows. But that’s been a really tough nut to crack for us, mainly because he seems to have a period of very high insulin resistance stacked up against a period of very high insulin sensitivity. We’re still working on it, but if we lower his basal, he goes high, then goes low. And if we lower his carbF, he goes high, then goes low. If we prebolus far enough in advance to have no spike, then we get a tail of ever-rising blood sugar on the other end.

In the meantime, because he is tending low frequently at preschool, we need to have a protocol that will keep his BG up for at least 1.5 hours (about the time between his snacks/meals at school). Right now our protocol involves the preschool teachers popping a 4gram gummy in his mouth and then going about their day, keeping an eye on the numbers till they rise and giving another if they don’t.

If we need to add something with more protein/fat, then it has to be something that can also be easily popped into his mouth, that he likes, and that doesn’t take more work for the teachers to administer. I’m thinking maybe something that’s more like a nutty type of chocolate?? Maybe like a Whopper or something?? And if we do need to add the fat/protein which may delay the rising blood sugar, we will also need to adjust the thresholds for treatment, to allow an extra 5-10 minutes for numbers to come up.

@Tia_G Certainly, it’s almost always easier to say address the underlying cause of a low or high than it is to actually do it! In my experience, as soon as I work something out my buddy decides to change anyway, such is diabetes at times I suppose.

Could you try giving him the 4 gram gummy, waiting for his numbers to come up, then giving him another snack like a nutty chocolate or something, that might have a bit more of a slower rise. That way the fat and protein aren’t delaying the initial correction, but you’re getting the added longevity of the fat and protein in maintaining the blood sugar at the desired level? I wonder if you could even give him a few spoons of peanut butter? Perhaps that’s too impractical, I don’t have a child so I often overlook the practical side of these things :frowning:

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Yeah, I recommend adding the longer acting snack after the short acting thing like a gummy has had a chance to work, if at all possible. Definitely don’t combine together, or it will be delayed in bringing it back up in the first place, which means feeling awful longer. The classic example from the hospital was always some of those pre-made peanut butter crackers in the package, after the juice or glucose tabs (or gummy) has had a chance to work. Some choc-covered peanuts/peanut m&ms might work well too.

If 4g raises bs 30pts to safe point, that’s good. He will need a protein source to sustain that otherwise the “quick” sugar will burn off and he will be low again. I usually have something with a little peanut butter for the protein after I bring up my lows unless I am getting ready to eat a meal.