We had a very scary episode tonight with my daughter that I cannot figure out.
She checked her sugar at 4:50 pm to she was 85
She ate and then dosed herself at 5:11 pm (20 mins after sugar check.) She had tombstone pizza, fruit and salad for supper. With Tombstone she has always had good stable sugars.
At 5:30 she had a BG of 30!!
Besides the 5:11 dose she was dosed at 11:30 am for lunch. She is on a pump and her basal rate has not changed in 2 months set at 0.3
Yes - please do not eat such fast-acting and high carbohydrate meals! It is hard to calculate the carbs accurately, and even a 20 % margin of error can mean she has injected way too much insulin. Sorry I am not able to express this in mathematically vivid terms. However, this has been expressed as the "Law of Small Numbers" by Dr. Richard Bernstein, in his book, The DIabetes Solution. His recommendations are pooh-poohed by the American Diabetes Association, but it has helped thousands of Type I Diabetics around the world, including myself. I do not follow his dietary recommendations to the letter (and he gives other aspects of diabetes care which I have also found very useful), but understanding the principles of his advice has enabled me to have much more stable blood sugars.
Finally, her BG may have been on the way down when she took insulin, especially after a twenty minute gap - the recommendation is to administer insulin within 15 minutes of testing - particularly when any drop at all from her BG level could have been problematic.
Keep in mind that BG meters are not 100% accurate, so it's possible she was actually lower than 85 at 4:50, and also possible she was heading down rather than stable at that point. Does she normally recognize low symptoms and did she feel 'ok' at that point ? Had she been more active between lunch and dinner ? Did you review the bolus history and confirm there was not a overbolus or IOB that wasn't accounted for ?
Also, was there a recent infusion set change ? Sometimes I find the insulin seems more 'potent' the first day.
Bottom line is that there are SO many variables and possibilities, that yes, it does happen from time to time, and many times there's no way to really know the reason. But sounds like you caught it, and knew what to do !
Yeah she felt fine thru dinner and she does a good job at recognizing her lows. This seemed to come on all of a sudden. I know she bolused correctly as we still check her number before she confirm it.
its really scary, the insulin she took at dinner would have only been in her for 20 mins which is really fast to have any impact on her from what we experience in the past. That would leave her basal insulin causing her to drop which again is strange since its only 0.3. This is the kind of stuff that scares me to death when she sleeps. Diabetes always has to throw us curve balls.
It sounds to me like she was on the way down when she tested and then bolused. Her body my not have had enough time to digest the carbs she bolused for. I also find that some processed foods (id. Tombstone pizza) are not all the same. They all are supposed to have the number of carbs on the label but often do not. My 10 yr old likes carbs, but we have started to stay away from processed foods and make them homemade. That way I know how much flour, sugar, dairy, etc. is actually going into them.
Does she do like a dual wave bolus for things like pizza? I've just recently started pumping myself but my CDE said things like pizza if I eat it I should use the dual wave feature because they are slow absorbing carbs and the high will come later. Basically meaning if I use a normal bolus I have all this insulin upfront, but the carbs haven't really hit hard yet, then when they do hit hard, its when the insulin from a normal bolus is wearing off. It might be worth trying next time she wants pizza. And I agree some prepackaged food, especially like a pizza where you have to slice it yourself, what I think is a serving size and what they think is a serving size might vary considerably, thus throwing off your calculations. And I agree as well sometimes in prepackaged food THEIR count might be off slightly too.
That's happened to me too though BG fine before eating, bolusing for what you eat, and then bam hitting you like a ton of bricks only 30 min to an hour later. Even on the pump I had that happen the other day. Does she use CGM with her pump? Otherwise it would be hard to know if she was dropping prior to taking her bolus. I guess if she doesn't...maybe she could do like a pre-eating BG check just to see where she's at, and then wait 15 to 20 min and do another to see if she's dropping any or if its relatively stable. So many things to consider and juggle isn't it?
