First sudden plunge


(Cathleen) #1

My daughter had her first sudden drop in blood sugar a couple of nights ago and I didn’t handle things well. I think I figured out why it happened. She had eaten a granola bar about 1.5 hours before dinner and had spiked up, then was heading down as the insulin kicked in. I calculated a correction at that point and also rounded up on her dinner carbs because she had been running high all day. About an hour after dinner, she plunged from 223 to 60 in about a half hour. Her new Dexcom was showing double down red arrows with no apparent end, alarms sounding on three devises…it was like watching the stock market crash. We started with fruit juice and it didn’t seem to take effect, then moved on to fruit snacks and glucose gel. Finally, her numbers turned up again. I think I gave her about 70 carbs total, I’m embarrassed to say, and then she spiked up overnight over 400. I was truly terrified and overreacted. Worse, my daughter was scared and tearful. As a psychologist, I didn’t practice what I preach! The doctor on call was helpful and did not want to treat with more insulin that night and her carb ratio was changed for the next day. I learned that we should have done a finger poke right away and not rely on the Dexcom. I was reminded to use the “15 gr. carb, wait 15 minutes, then re-test” rule. But, how do you know if that will be enough to stop the rapid plunge? And how do you have patience to not overdo the carbs? Live and learn, but this is truly challenging.


(Wendy Spencer) #2

Hi Cathleen. As a parent, I also find the lows really scary. So, I am afraid I don’t have any advice for you - just to let you know that you are really not alone in this challenge. The overcarbing is quite common I would imagine, as I would far rather overshoot the target than let the low set in. Sending best wishes to you and your daughter!


(Cathleen) #3

@francesjean, thank you for your kind words, they really help. It seems things go smoothly for a bit, then a shake up, then we recover somehow. All the best to you and your child, as well.


(Dennis J. Dacey, pwD) #4

Oh Cathleen @cminer, please try not to feel embarrassed at what you did or by the results - even after more than 60 years living with my diabetes and using insulin I react similar to the way you did. Yes, seeing that double arrow down and seeing the DexCom receiver turn RED I can appreciate your apprehension. Last evening I had double down arrows and a red screen on my receiver - I attribute that to possible excessive activity and need to adjust my supper-time carb ratio; it is now adjusted.

A couple of things that you and Kate should observe:

  • If she ate the granola because her BG was lower than she wanted and didn’t take insulin, or if she ate the bar and added insulin, she probably should avoid a correction dose especially with her BGL going down.
  • Let her try this experiment when her BG is in-range and she hasn’t had unusual activity. Write down her CGM reading and drink 15 grams of carbohydrate - the usual juice you have on hand, and watch for when her glucose level begins to rise. What I’ve seen since using my Dexcom G5, my BGL does not begin to climb before 30 minutes. Write down her BGL [Body Glucose Level] at 15 minute intervals and she then can calculate her rate of rise for every gram of carbohydrate.
  • Going “HIGH” after a hypoglycemic event can be the the result of at least two factors: her body’s natural release of glucagon by her liver to self correct the hypo, and her/your very natural reaction to force her up - yes, I almost deliberately over-treat my lows [I’d rather be higher than lower] especially before bedtime.
  • Treating the resulting “over 400”: her doctor is being cautious as she should be. Personally I do make very conservative/cautious corrections during the night.
  • Dinner-time ratio: yes, adjust to lessen the amount of insulin delivered, and try to avoid “over-counting” the number of carbohydrates in a meal. If you think additional insulin is needed, make another correction. Does Kate use a pump? What model?

I think I will stop here, let us know how she, and you, are doing.


(Andy) #5

I’ve tried unsuccessfully for the past 30 years to convince my wife (and subsequent children) that turning the house thermostat to 85 degrees DOES NOT heat the house any faster than setting it to 68.

Now I’m having to remind myself that the same holds true for ingesting emergency carbs to treat lows. Sadly, that realization usually comes when my Dexcom receiver starts screaming “What the hell are you doing! Trying to break some high sugar record?”

Don’t be embarrassed. It’s all a big learning curve and really, it’s hard to score a touchdown when the body keeps moving the goalposts.


(Cathleen) #6

@Dennis, this is excellent information that I will be reviewing again!
We will try the glucose experiment to get a general baseline. And, very interesting about the body’s natural release of glucagon after a low. The wisdom of the body, even when it is under autoimmune attack is amazing. I have been overall more conservative with corrections and no longer “rounding up” after this experience.
Eva is 13 and about 4 months into her diagnosis. We are starting to investigate pumps, perhaps the omnipod, and are getting used to the dexcom technology. She has not minded the shots and gives them herself, knows when to eat a small snack to correct while out on her own. I’m still assisting her with carb counts and dose. It is overwhelming for an adult, I wonder how a teen will be able to take over on her own, but I’m glad we have 4 years of high school ahead to gear toward independence. (It’s interesting to see that, of the 6 kids in her school with T1D, only 2 have cgm and none have pumps, with all except for her being diagnosed as very young children.)

@AJZimmerman, thanks for the laugh and the thermostat is a great analogy that we will remember!


(heather) #7

It tskes some time to really get ahold of this disease for you or your kids i been type 1 since 2002 and still have trouble managing blood sugars eating right and guessing the correcr dosage for meals every day is a new challenge to take on the one plus of being a diabetic is it makes u a stronger person it all takes time but i also do promise it gets easier to deal with u shouldnt stress too mich it happens to the best of us ! You did your best and that is all that matters


(Fiora) #8

Hi Cathleen,
You’ve gotten great advice, I just wanted to let you know I have been there. And it’s really, really scary.
Some rules of thumb from our pediatric endo:
Always double check with a finger prick (as you know)
Don’t correct if you have eaten carbs in the last 3 hours or if you’ve treated a low in the last 3 hours. Meaning if I gave my daughter a snack I thought could be uncovered and it caused her to be high, I know why that happened and it wasn’t the fault of the previous insulin not being enough.
My daughter is almost 4 and I have had one of those episodes. It was just a honeymoon symptom of last nights great ratio all of a sudden being wayyyyy too much. I watched her dexcom freak out and pricked her finger 3-4 times in an hour. At that point you’re just feeding the insulin to catch up.
I try to remember her actual blood glucose number is the right number, the dexcom is measuring something else and runs about 15 minutes behind. (And sometimes can be totally off and needs to be calibrated)
I’m sure if this happens again you’ll be calmer and feel more in control with the knowledge your endo imparted and you gleaned here. You’re doing a great job!


(Cathleen) #9

@Hmonty26, Heather, thank you so much! I hope in time this will become more manageable. In 4 months, we have already learned a lot, with so much more to go. I see you are very strong because of type one and I wish the same for my daughter!

@Fiora, Flora, I really appreciate your encouragement. This forum has been a blessing, with such knowledgeable folks! Our endo is great, but some things seem to be learned by experience, and there is a fear of messing up or missing something in the beginning. The tips about not correcting when she has eaten carbs in the last 3 hours, and “knowing that it wasn’t the fault of the previous insulin not being enough” are really good. And, the fact that the Dexcom is 15 minutes behind is important to know. I will feel a bit better prepared next time! I wish you well with your sweet 4 year old.


(Fiora) #10

@cminer, I jinxed myself, it happened to us again tonight! Because I had just typed it out to you it was easier to take my own advice (and still she is now 187 and headed up)
We are also only 4 months in, diagnosed in October, I think that’s what’s so great about having a place to share experiences, helpful tips, and so on. We are all in this together.


(ksannie) #11

The 15-15 rule is actually not much help. If I were to eat 15 grams of carbohydrates when my BG was 55 and my Dexcom was beeping, my BG would eventually rise to 130 or more. (15 grams of carbs raise my BG by 75.) But after 15 minutes, my BG would likely still be 55. My BG would get to 75 after about 45 minutes, and not peak at 130 until after an hour. If I followed the 15-15 rule, and my BG was still 55 after 15 minutes, I would be expected to consume another 15 grams of carbs which would eventually raise my BG to 205. And when I say eat 15 grams of carbohydrates, I mean glucose tablets, which are quick-acting. They take an hour to raise my sugars back to normal. I don’t understand the 15-15 rule, as it is not individualized enough. It is a starting point, but should not be considered a “rule.” If my BG is 60, then I only need 8 grams of carbs to raise it to 100, and that will take a whole hour, not 15 minutes!


(Joy) #12

Hi Cathleen,

So many helpful answers you got, this site is great!

Here’s another tidbit I’ve learned: remember that your Dex has about a 20 minute lag time. It’s measuring interstitial fluid, which is not as up to the minute as blood. When my Dex wakes me up because I’m 48 in the middle of the night, I drink my 15 carbs of apple juice (the little pre-packaged kids juice boxes are perfect because you don’t overcorrect) and then shut down the Dex so it won’t keep waking me up every 5 minutes for the next 20 minutes. I know from experience my sugar is rising, and that the Dex just doesn’t know it yet.


(Dennis J. Dacey, pwD) #13

Thank you Joy @wings88 for this reminder. I’m aware that my G5 does not show my BGL beginning to rise until about 39 minutes after IV drink my juice.

I knew of the belay and the reasons for different reasons, but at 3 AM my thinking isn’t “perfect”.


(Joy) #14

Me neither. Just want the Dex to shut up so I can roll over :smile:!


(Dennis J. Dacey, pwD) #15

Hi @ksannie, are you speaking BG [Blood Glucose] as from a finger stick or BGL [body glucose level] as a CGM reading from interstitial fluids? There is a difference and the only time they are the same is when both have been level for some period of time and you have not eaten or engaged in any activities. When glucose levels are changing up or down, interstitial readings tend to lag behind blood levels by 15 to 45 minutes.


(Cathleen) #16

@fiora Flora, I’m sorry that you had to go through that again, but glad that it was easier this time! It is a bit traumatic and took me a couple of days to recover from feeling nervous. I used your advice about the carbs around dinner time this week, thanks again. I wonder how much of the roller coaster is due to the honeymoon period our children must be in 4 months after diagnosis. Hoping things will even out as the system stabilizes.

@ksannie and @Dennis Thanks for the thoughts about the 15/15 rule, it reminds me to slow down and think!

@wings88 Joy, I really like your process. You sound calm and experienced with this and it is reassuring. I bought some juiceboxes this week. It’s as if they are packaged at 15 grams of carb just for us!


(Jay) #17

Well good news is she’s ok and sounds like she will be good for a long time if she is on Dexcom. Just imagine if you didn’t have a CGM like back in my day, scary to say the least. It also sounds like she didn’t have a sezuire, so that’s good, you might be at a different level if she did. But even if she did call 911 and use glucose pen and know she will be okay, even if it fells like it’s not.

Hopefully, in 10 years this will be something you can just look back on with laughter on the situation since you will all grow so much in education and expierences. We all have these stories and they are the days we grow and learn from. I still tease my parents today on the crazy things they done to me like Mom giving me 2 shots for dinner, oops, and dad giving me a gallon of Gatorade to fix. Ugh no. They were a bunch of Rookies.

But, ultimately you need to read a little about IOB or Insulin on Board and remember that it is there. There are several apps you can get to help you record and know exactly where you are with insulin.

Insulin takes time and results may not realized for hours. Remember this.

In addition, correction glucose is not instant and you need to be patient. Calculate how much insulin was given and how many carbs for last 4 hours, is it off? If so take the correct amount of carbs to bring you back to goal. Write the formulas down so you know them quick. If it is correct was their other issues like sitting in sun, working out, walking longer distances in day than normal, stress that would effect glucose reading? Make a list of things to check and numbers to calculate to help in these situations. This might keep your focus on the problem and not the emotional part.

My main advice I can give you is it sounds like you are a good and concerned parent. Your child probably has some need right now to please and satisfy their parents. So when these situations occur, take it with grace. Please don’t get hysterical or yell at your child, even if sugars are high. They are both dealing with diabetes and their parents. I can tell you it is very hard. Sometimes you will need to scream, but do it away from your child.

I would like to tell you this will never happen again, but it will. So just remember to keep a level head and go through your check list.


(ksannie) #18

I do use a Dexcom so that it wakes me up if my BG is low at night. But the hour it takes to raise my BG is the same whether I use a finger stick or Dexcom. I remember one day when my BG was in the 30’s and I was so low it was hard to make myself do what I needed to do. After consuming the carbs, I watched the Dexcom and confirmed with a finger stick, because I find the Dexcom less accurate for very low BG’s (below 60).


(Dennis J. Dacey, pwD) #19

It sounds like we have been through the same kind of lows - for me many times during over six decades living with insulin. After those “lows” which I often “over treat” I just plan for the next day starting off sky-high - but I’m more cautious about over-correcting and driving myself down too far.
I think you and I can both agree that now we have the tools to better spot when our BGL is dropping and when the recovery begins so that overindulging on juice, cereals, cookies and whatever else the way we did when it took days to get the result of a “blood sugar test” from a lab.


(Louis) #20

20 carbs is all she probably needed , when you get a low most people over correct , that’s why you had a 400 , 70 carbs is alot , keep at it discipline is the key !! Dexcom was probably dead on , they are awesome, some times 20 carbs followed by protein is the key !