When is a low a low?

Question here… so my daughter feels ‘low’ anytime her blood gets below 4.5 (81). She feels weak and shakey and so we treat.

Seeing as she’s only 10 so I’ll often get up in the night to check her - especially after we make basal changes, and if her bg reading is below 4.5 (81) I’ll give her juice assuming that she’s having a low and I don’t feel safe until her bg is above 6 (108).

However I was just talking to a friend whose daughter is also diabetic and she said that it’s the same for everyone, you aren’t low until you are under 4 (72), even if you feel shakey and weak. She also said that if I check my daughter at night and she’s above 4 (72) to just assume that it’s OK - my daughter will wake herself up if she’s truely low and not to treat.

This seems very contrary to how I’ve been thinking all along so I would appreciate your thoughts. :slight_smile:

oh - and my daughter has never woken up when she’s low… even once when her bg was 2.4 (43)!!!

Personally, I would err on the side of caution and treat with a small nudge but that is me. I often treat with a small nudge in the middle of the night.

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I would not assume 72 was ok unless there was a CGM involved with a trend line. At 72, she could be dropping and be in trouble quickly. And people feel the symptoms of a low differently, sometimes the symptoms are different for the same person. I was told a long time ago never to go to sleep unless I was above 100. I still try to follow that rule. We are all different, but that works for me.

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Sometimes PWDs feel low in the 80s if they are running high a great deal of the time. (Not trying to imply this is the case with your daughter.)

Back in the day when my teen daughter was not refusing to wear her Dexcom and I was on her Share list (instead of her $h1t list), I assisted her in running a significantly tighter D-ship. She didn’t feel low until she was in the 50s. Fortunately, those lows were quickly and easily corrected. How I miss that seemingly endless series of low A1c’s and low SDs… :cry:

I could be mistaken, but lots of (if not most of) kids don’t wake up to lows. Mine never has. Thank G-d for Dexcom (if you use it.)

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I often feel low if I’m dropping rapidly, even if I’m not actually low yet. If I was 4.8 and feeling low, I’d eat something.

I’ve had diabetes for over 25 years and almost never wake up for lows.

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You must still be a child at heart! :relaxed:

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I don’t feel that an 80 overnight is the same as an 80 during the day. I would caution against a rule of anything above 72 should be left alone, particularly, as @KCsHubby_Dave says, if there is no directional information available.

It varies for Caleb - he can feel fine at 70 and low at 90. Sometimes we can’t explain it. Sometimes he’s dropping and that’s why he feels low with an otherwise “in range” number. There is no doubt though - Caleb does NOT wake from a low. No chance, sundance. :wink:

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For me, the borderline lows (say, 70-80 ish) tend to have more symptoms if I’m actually in the process of dropping further, so assuming you don’t have a CGM, I’d err on the safe side and treat especially before bed. If it’s not before bed, maybe try only part of what you’d give for a lower low, and then test a little while later. If she’s 80 and feels fine, and you have the ability to hold off and test in a little bit, you could try that and see what happens. All of this is pretty individual, so understanding how to read one’s body’s signals (including whether they can be counted on as consistent indicators or not) takes some trial and error.

I am pretty sure I always woke up from lows as a kid (and still do usually), but I think that goes hand in hand with having a generally highly reactive sympathetic nervous system, which is what drives the some of the low blood sugar symptoms and the waking up response. My guess is kids/people who have generally stronger tendencies toward quick spikes in heart rate, getting sweaty when anxious, etc will have stronger and more consistent low symptoms that interfere with sleep.

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To echo what others have said, not every 81 is the same. There is a flat 81, a dropping 81, a plummeting 81, an 81 with a lot of insulin pushing it. Not all 81’s are the same! So treat accordingly. Sometimes I start to feel low long before my blood test shows it. Eventually the blood test will catch up and show the low, but I learned to not wait.

That is just plain wrong!

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It’s technically true that one isn’t low under they are under 4. What we are really talking about here is not the fact that 4.8 is low, but the fact that 4.8 with symptoms may herald the approach of a low. It is good to avert a low before it happens rather than wait until actually dropping low to treat.

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That is most certainly a hypo level for a female child. It’s always scarey stuff. Venous BG under 2.2 is the medical hypo for a child.
http://emedicine.medscape.com/article/767359-overview

With the variability of home testing, 4.5 for a child on a normal diet is well within the recommended range of what’s called a low. As said, I would think IOB is a big factor on urgency too. as well as, if the BG is roller coasting with swings

following normal high carb advice, 4.5-5 would be treated with glucose

If you are having trouble with swings, reducing the sugar and starch carbs may help some

I agree that we are all like snowflakes and unique. I would add that my PERSONAL feelings of low vary. For example, just before lunch today I was out being active and when I sat down to bolus for my meal, my BG was 57 mg/dl (3.2 mmol/l) but I felt fine and was able to “correct” by adjusting my bolus dose. On the flip side, I’ve had heart-pounding lows that have me sweating and panicking but when I check, I’m in the high 70s (around 4.3 in mmol/l).

Thank you all!

I like this Eddie, very good insight…

You are so right! Good point! And it’s true, sometimes my daughter can sometimes feel herself coming down when her bg is still 6 (108) and I’ll say, you aren’t low, and then 1/2 hour later she is low. So I just trust her now and let her treat.

And unfortunately that is probably the case for us… our last A1C was bad and it’s because she doesn’t bolus for snacks unless I’m standing right over her saying, bolus! Which I could/should be, but I have 3 other kids and I can’t see what everyone is doing all the time!. We are getting better now, but I’m finding that when we are running a tighter ship we have lows more often… but she’s good at feeling them. We need to get a CGM, I know it would help a ton.

Ok, so I will keep treating what I consider ‘lows’ at night - at least until we can get a CGM. And for the other lows, I will just trust my daughter and let her treat.

Thanks again everyone, we will keep plugging away at this. For some reason nights just scare me, but this could be because we have already lost a child (8 month old baby who needed heart transplant) so I know the pain of losing a child and I do NOT want to go through that again if it’s on my watch, that’s for sure.

I appreciate all of you so much, just love having other’s to turn too when we need help and advice.

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Best of luck to you. When in doubt, trust your instincts. Sorry for your loss.

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Also keep in mind that BG meters are not as precise as we want them to be. So a ‘real’ 81 may show on meter as 69 - 93. So how she is feeling is important, although can also be misleading.

If she’s been running high a lot, that could very well be related. I find that even just a few days of running high cause me to feel low-ish at a normal BG level. So it doesn’t take much at all to cause that.

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I am so very sorry to hear that you lost a child. Sending positive thoughts your way. Hang in there. :heart:

Before Dexcom (STS3, April 2006) I would only be awakened from a low at night by the paramedics while they were carting me off to the hospital. And I never went to bed with a Bg below 100.

The nocturnal lows still happen occasionally but the Dexcom will wake up my wife, and I can treat before disaster sets in. The lows have always been worse on her than they have been on me.

Ack! Ok doc77 that’s crazy! But it goes to show that everyone is different and I should not expect Sarah to wake up from lows… especially when she never has up till now!

I never feel my lows at night, never wake up due to them. Thankfully as a child my dog would let me know. Then my husband would tell me. I have a CGM, but unfortunately I’m one of a few who has a problem where the CGM more often than not up to 80%+/- off from their blood sugar readings, the reasons are unknown. Calibrations are done correctly and no medications are taken that can interfere with readings.

But every person is different for when they feel lows. I feel myself dropping around 80. When I’m at 60 I get a stomach ache. When I’m at 55 I become silly until I reach 50 then I’m back to my normal self.