Active insulin hypo

[suki2016]

Hello everyone! I have a daughter who is newly diagnosed with Type 1 diabetes at 21 months old. Does anyone know when the diabetic still has active insulin in their body and u test them and they are under 4mmol is that accurate or should it be treated as a real hypo?

 

[Kittycat_7_]

Obviously difficult to access a hypo in a toddler, if the BM is below 4 then treat as a hypo.
In time you will begin to recognise behavioural changes that point to a hypo.
I'm so very sorry your daughter has diabetes at such a young age.
How was she diagnosed? Was she drinking lots etc
Welcome to the forum
Take care

 

[himtoo]

Hi there @suki2016
welcome to the forum !

from the description you have given in your topic--

I would expect your daughter is on an MDI regime -- that is a long acting insulin ( lantus , tresiba , levemir )

and a fast acting ( novorapid , novolog )
if so , there will hopefully be patterns to look at in blood sugar readings.

has the low blood sugar happened withing 3-4 hours after a meal ??
are you getting low blood sugar readings in the middle of the night ??

it is difficult from your post to be sure what you are asking ?

if I read correctly -- YES -- if i have active fast acting insulin still on board( within that 4 hour post meal injection ) and I test below 4.0 -- then that is a hypo brought on by the fast acting insulin .

 

[suki2016]

Yes she is on lantus and novorapid. So do i treat the hypo? because I keep getting told by my diabetics to team to only test at meal times and not in between but sometimes I check her regularly in between because she can't tell me how she feels and I see she is low but seems fine within herself? Don't know what to do really?

 

[suki2016]

Hello kittycat, yes she was drinking lots in the summer, at first we just thought she was thirsty because it was hot but then the never-ending wet nappies starting for 2 weeks and a horrible nappy rash started that wouldn't go with nappy rash cream-that then alerted us to go to go to get her checked out.

 

[Scott-C]

Yes she is on lantus and novorapid. So do i treat the hypo? because I keep getting told by my diabetics to team to only test at meal times and not in between but sometimes I check her regularly in between because she can't tell me how she feels and I see she is low but seems fine within herself? Don't know what to do really?

I think you have misunderstood the advice, or those advising you are incorrect. The general advice for newly diagnosed people is don't test between meals, but do test if you feel hypo. It's obviously more difficult doing that when the person involved is a child, as you do not know exactly how they feel. But, as a parent, you will have a sense when something doesn't quite feel right, so test, if below 4, that's a hypo and needs some sugar immediately. I don't know enough about how to treat type 1 in children to say how much sugar is needed, you'll need to speak to your advisors about that. But, yes, if levels are below 4, that is a medical emergency, and needs sugar straight away. An adult will normally need about 10 grams, but check with your advisors on what is required for a child. If your child is actually below 4 just now, give her 10 grams anyway: it won't do her any harm and will get her back above 4. Test again after 15 minutes snd give more sugar if still below 4.

 

[catapillar]

@suki2016 any reading under 4 is a hypo. It doesn't matter if your daughter "seems fine" (for gods sake shes a toddler, you could probably hang her upside from a plane and she'd seem fine) a hypo isn't determined by how a person feels or seems, it's determined by the number on the monitor. If that number is less than 4 it's a hypo and it needs treating. It doesn't matter what time of day it is, when the last meal was or when the last insulin was, none of that changes the fact that a number under 4 is a hypo that needs treating.

 

[jaynepresland]

Yes she is on lantus and novorapid. So do i treat the hypo? because I keep getting told by my diabetics to team to only test at meal times and not in between but sometimes I check her regularly in between because she can't tell me how she feels and I see she is low but seems fine within herself? Don't know what to do really?

Hi ya, firstly I'm so sorry that your little girl is type 1. Secondly I think you're doing a great job. I always test my bs between meals. As others have said always treat a reading under 4.

 

[donnellysdogs]

I have a concern here, how many strips are you getting per month?

You should be getting enough to test whenever your daughter needs and you feel that she may be high or low.

Are you testing over night?

You should not be on high alert for hypos or generally overly blood testing but you should be able to test when you think its needed.

 

[suki2016]

As she is so active around the house she can become low. I put her ratio up to decrease insulin but it's still happening.....this has only started happening in the last few weeks......its so draining having to keep being aware of hypos in such a young person.

 

[suki2016]

Is lantus mainly a stabilizer at night or day too? Is is just to prevent hyper?

 

[himtoo]

Is lantus mainly a stabilizer at night or day too? Is is just to prevent hyper?

hi there @suki2016
perhaps it would be a good idea for you to buy the book --- Think Like A Pancreas.

Lantus is a background insulin that is intended to keep blood sugars level and stable over a 24 hour period

Bolus insulin ( novorapid ) is taken to control blood sugar with food intake

 

[suki2016]

Hi donnellydogs,

I get 300 strips a month that was changed from 150. I test her 4 hours after her last meal and give her 7 gram free carb if low or if she is under 6mmol and correct if high over 14mmol.

 

[suki2016]

I bought the book already. Lantus I already know is more of a stabilizer when the body is fasting and doesn't go to high when glucose is secreted from the liver but I I've been told it stabilises hypos......not sure about that with my experiences with my little one.

 

[catapillar]

Is lantus mainly a stabilizer at night or day too? Is is just to prevent hyper?

What do you mean by stabilizer? Lantus is an insulin, all it's doing to do is lower blood sugars. It won't magically raise them if blood sugar is dropping. The job of a basal insulin is to keep blood sugars flat-ish when not eating or using bolus insulin. The basal insulin can only do that if the dose is correct and things that effect the dose would include growing hormones, waking up hormones, activity levels, illness, sleep consistency, temperature, change of scene. It's perfectly possible to wake up high having had hypos overnight (either because of dawn phenomenon - to be honest I wouldn't really expect an under 2 to have any significant wake up hormones going on to cause DP - or because of somogyi effect where a hypo causes an alpha cell response - that's the release of glucagon from the pancreases in response to a hypo which tells the liver to release its glucose stores and the body release adrenaline to combat the hypo which raises blood sugar and creates a bit of insulin resistance) so if your daughter is waking overnight - I'm assuming she might wake now and again to ask for mum, a change, a drink or some play dough- you really ought to be testing her.

Assuming lantus is a stabilizer or stabilises hypos is really expecting a bit much from a basal insulin. And suggests you don't really understand what the current insulins are or how they work. They don't turn off and stop lowering blood sugar because you are hypo. Once they are in they are in and they don't stop going. The only thing that stabilises as hypo is to eat something. An alpha cell response wears out if it's over used and it's the last line of defence against dying from a hypo - you really don't want to be relying on a alpha cell response to wake you from a hypo too frequently.

How long has your daughter been diagnosed? You've been a member since October. Where are you based, in the UK? Are you getting support from your DSN?

 

[suki2016]

My daughter never wakes up during night from hypos. It's more during day when she is very active and sometimes upon awakening because she sleeps for over 12 hours.

 

[suki2016]

I always treat her hypos during the day with fruit puree as I test her often. But my diabetics team tell me not to test too often which is hard to do as she is very active.

 

[suki2016]

He normally gets 2/3 hypos a week but last few weeks it's been a bit more often.

 

[donnellysdogs]

Ok....

Well if you are bolysing for meals.... the bolus is most active at 2-3 hours after.
So personally I would advise testing 2-3 hours after eating..... if she is 4-5 during this time it is likely that with activity that she would go hypo by 5 hours after that meal without a small snack (no bolus).

I know 14 is mentioned as your upper limit for daughter and its still early days but I would discuss with DSN whether this upperr limit can be lowered down over the next few months.

Do you ever do any checks over night?

I am glad that you have more strips now...

 

[Crystalwand]

Please please take note of the comments so far, these people are really good in what they say take care of yourself too