First sudden plunge

(Cathleen) #21

@Jayserna Jay, thanks for the advice and I will study up about insulin-on-board. Just like your parents were, I am a “rookie” in life once again!

@Louislucido Louis, 20 carbs sounds good with some protein. I feel more prepared, thanks so much!

(Cindy) #22

Lots of good advice here, especially not beating yourself up over any of this. You are doing the best you can, and it will get easier!

That said, I think a few things might be going on. First, regarding highs and lows, patience is key. I’m a type A personality and a mom of a T1D teen so patience is not my strong suit. Be careful not to stack insulin when you are treating a high. Try to Refrain from giving a correction more often than every 4 hours, otherwise you will be correcting while there is still insulin board or insulin which is still active, setting yourselves up for a hypoglycemic event.

Regarding the lows, patience again is important - Easier said than done with the Dexcom screaming and your kiddo not feeling well. Before the G6, I would make my son test to confirm the low before testing. Now we rely on the G6 most of the time unless it really doesn’t make sense because it has proven to be dead on most of the time. If low, my son has 15 “quick” carbs - and not all carbs are created equal so be careful when you do the test another person described. If, after 15 mins, Dexcom still in low range, I have him test. Remember that the Dexcom measures glucose in interstitial fluid, not serum, so there will be a lag before the IF “catches up” after treating a low. If he is still low but BG rising and he isn’t symptomatic, we just watch closely and reassess in 15 minute intervals. If BG is the same or lower or if he is symptomatic, we treat with another 15 grams. This happens most often when he has insulin on board from a previous meal where he may have overestimated the carbs. This approach has worked well for us and has resulted in far fewer episodes of overtreating.

Finally, with all the good advice out there, T1D is definitely not one size fits all. What works well for some may not for others. It helps to be open to new ideas and new techniques - you will learn a little at each step and it will all start to come together. Be patient with the highs and the lows, and especially with yourself! :blush:

(Cathleen) #23

Cindy, thank so much for the encouragement, reminders and tips, from another Type A mom! This process really does test the patience. Planning is helping me get a handle on my fear response to the lows. May I ask, do you follow the quick-carbs with a slower carb or protein after an event like this to help stabilize? Which types of foods do you choose? Eva’s low times seem to always be before bed. I am glad to hear that you are having far fewer episodes and your approach sounds very practical. Best wishes to you and your teen!

(Cindy) #24

Great question. Most times, especially overnight, we treat my son’s lows with chocolate milk. The sugar is fast acting and the fat and protein help stabilize his sugars. The fat also slows the BG rise compared to Apple juice, for example, but understanding that helps us avoid overtreating. That’s why, if it’s still low but going up and assuming he feels ok, we just watch closely rather than following immediately with another snack.

Before bed, we often encourage a meat or cheese snack with no carbs. That way we don’t have to give insulin and worry about IOB and you get the stabilizing effect as previously mentioned. He is also an athlete so this helps mitigate the crash hours after a game or practice.

Happy to help, feel free if you have any more questions. Good luck!

(Cathleen) #25

@cerrocc Chocolate milk! I had not thought of that option…great idea. My girl is fussy and I’ve had trouble finding quick protein options. She will do peanuts or a hard-cooked egg, but doesn’t care for cheese and quick meats. She is so sick of peanuts and peanut butter at this point, I am on the lookout for new options. Thanks again for sharing what you’ve learned…

(Cindy) #26

If you really want to pack in the protein, you can mix in some powdered peanut butter like PBfit or PB2. Makes it taste like a choc PB shake and adds a fair amount of protein without too many carbs or sugar like regular peanut butter.

(Nick) #27

I just am new to this forum my sons was diagnosed year and a half ago, and I’m grateful for all this information really helpful. Last night my son Went low and I still get very rattled.
I have to remind myself finger poke, 15/15 rule and I do a lot of praying. His skin changes color and he gets sick. I hate this disease but it is what it is and I’m grateful for all this information

(Nick) #28

Sorry for the grammar I voice texted fast at work

(Roger) #29

All of us have gone through what you and your daughter went through. You are right patience is a key. and as your daughter grows you will figure whether 15 carbs initially is right or maybe 20. And your daughter must learn to try to not want to eat more because she feels “hungry.” Your daughter also has a great advantage, as I did growing up with T1D. She has you caring for her and helping grow with T1D.

God Bless, Roger

(Roger) #30

Great comments and suggestions Dennis

(Fiora) #31

@cerrocc you use chocolate milk as a low (under 70) snack? We were told any milk is a complex carb unless it is skim, and to use simple sugars under 70. I bought some chocolate milk and used 1/4 cup when my daughter was low (80ish) before bed and she was 300 all night.
For an under 70 low at bedtime they would have us do 15g of juice or maple syrup followed by a 10g complex carb, that’s way too much for my kid, I am thinking chocolate milk is a good alternative.

(Fiora) #32

@cminer, are you adjusting your daughter’s carb ratios yourself? I was taught to fix a low right away, but wait for a high 3x in a row before adjusting. If my daughter was going low at bedtime I would change her ratio.
(I’m sorry if this was covered before I’ve had a sick 2 year old and just catching up!)

(Marina) #33

When correcting for a low, I like using quick acting carbs ( like apple juice boxes 15 carbs/box) – a few potato chips — a few. Or a small bag of chips ( 15 carbs) for a longer lasting correction.
If you don’t get evidence of the correction fast enough — it could be a slow digestion (gastroparesis) I think this happens if you have had diabetes for a long time… The negative here is that eventually you will have a very high reading, if you keep correcting. In the 400’s, easily.
Then it is tempting to correct the high with insulin and we end up with an unpleasant yo-yo effect.
I have been able to stabilize digestion with a morning of aloe juice , and with the noon and evening meal.

(Marina) #34

That should have read of aloe juice and with the noon and evening meals.

(Marina) #35

enzymes with the next 2 meals

(Cindy) #36

Yes, we give our son chocolate milk for lows. Because of his dexcom, we usually catch it early before he crashes and he is usually not symptomatic. You are correct, the fat in the milk causes the BS to rise more slowly, but if he’s not symptomatic, we are treating the number rather than symptoms. Four ounces of our local brand Battenkill Chocolate milk is around 14 carbs so that’s what we usually give him. If he is crazy low (under 50) or symptomatic, we use apple juice or soda.

We use the chocolate milk for a couple of reasons. One, he never tires of it, he’s always willing to drink a glass. Second, because of the fat and protein, it tends to result in a more stable post low blood sugar so it’s usually one and done, rather than the repeat treating with simple sugars like apple juice. Again, this is for when he’s feeling fine and we are treating a number. The Dexcom is key to our success with this approach.

I have to wonder about what you said, that your daughter was 300s after 2 oz of chocolate milk. That provides less than 10g carbs so I’m not sure I would attribute the high to the chocolate milk - maybe something else is going on like her basal needs adjusting. Just a guess, but I wouldn’t expect that kind of rise from 10g carbs in any form, let alone chocolate milk with all that fat and protein. Certainly not one size fits all with T1D, but this has worked for us. Would love to hear how you make out if you decide to give it a try.

(Cathleen) #37

@nraia3 Hope things are going well for your son this weekend. Thanks for sharing your experience. I hate this, too. If I let myself think too much, I can go to a dark place. This forum certainly helps, to hear about so many living so well.

@T1DRoger Good point about the hunger. Thanks for your kind words about parenting.

@Fiora Hi Flora, we are still depending on the endo to guide us with ratios. Eva’s at .5 unit for 15 gr. carb during breakfast and lunch and .5 unit for 10 gr. carb at dinner. We correct highs at mealtimes if she is over 150. It is still tricky deciding to round up or down if she is at, say 45 carbs at dinner. I have been more conservative since this low happened. I think with more practice we might be able to start changing ratios on our own, as you are. Hope your 2 year old is feeling better now!

@mkurkov Marina, chips sound like a good longer lasting option. And, I just looked up “aloe juice” for future reference. Thanks!

(Charles) #38

I read all this and yep great advice so far! I’ll ad my $.02 and you can go from there.
What is most important in these lows is to not panic. From personal experience, I have learned to go slow and steady. You’ve heard this a few times already. But never hurts to hear it again. I personally feel better if I am high rather than low. I don’t reach for insulin to correct the high after dropping really low. I let it come down on its own. Usually within an hour or so.
I just want to sleep if I go higher than 250. I’d rather do that than the lows. The big problem I feel/see is getting this thing is getting it going like a yo-yo. Your daughter will feel like crap and not be helpful to you. Trust me on that! I know when I’m bouncing up and down I am a royal pain in the butt!!

I use a step method. I set my alarm at 80. It gives me time to help stop the low! I eat without any insulin and wait! I turn off the alarm and check 20 to 30 mins later. If I’m moving up, let it go… if not, another snack. Repeat above steps. Check again and if I’m moving up, let it go. If I go really high in the next hour or two, don’t worry, I usually take a nap. Check it in a couple of hours to se where I’m at. When itstime to eat, I check and dose myself accordingly at breakfast, lunch or dinner. Over dosing insulin produces this yo-yoing effect. Don’t reach for the insulin!!. Sometimes the body compensates for you and then you get the severe stubborn low that won’t go away! Don’t add to it!! It takes time and patience to deal with this!!

Oh yeah fun fact from me! Not every low is the same!! Not with me at least! Each time for me is a new adventure! You may have to let your daughter self treat due to how she feels on this. There is no rhym or reason to how this works! It does what it does and all you can do is react accordingly. But do it slowly and thoughtfully.
Don’t rely on if this does this I do that then inject more insulin! Adding the insulin creates more problems, at lest in me!
Problem is we want an instant fix, it doesn’t work that way! Just remember the rabbit and the tortoise! Slow and steady wins the race. At least for me it does. Everybody is different!! REPEAT! Everybody is different!! What works one time may not work again. Or it the best thing since sliced bread! No way to tell, just work with what is happening each time and slow and steady.

These lows are scary!! For you and twice as bad for your daughter! Her body is out of control! She can’t think straight and you won’t help if you overreact or panic. Deal with what, cgm, finger sticks tell you! But don’t go nuts with the insulin pen!! Wait and see what’s happening, add to it later not sooner.
Good luck

(Cathleen) #39

Charlie, thanks so much for your valuable input. I really like your process and will remember the tortoise and the rabbit. I have reset Eva’s Dexcom to 90 so we won’t feel so rushed. Every low is different…this is a true exercise in flexibility and patience.

(Charles) #40

It helps, but plz do remember that as panicked as you feel she feels worse. In those lows stuff gets foggy and not real clear! There can be moments which she won’t remember what she said or did. You’ll have to trust her that she’s telling the truth when she says she does not remember ABC…
It’s happened to me… that’s really disconcerting too! Especially when your told about it later. You really don’t have any memory of saying or doing things.
I promise you this is real and even has medical backing. Endo Dr told me about it and I never thought it was true till I did it.

Wake up moment for me! Scared the whizz outta me! As you said everyone is different. Each low is different too! As individual as we are.
Just thought you might want to know cause you may see it first hand and think she’s lying to cover a bad behavior… it might be real.
Just remember one day at a time. Slowly you will learn to manage the sugar levels better. The body is never really in stasis so everything changes every time.
Good luck