Child losing hypo awareness

If she is having a lot of lows , think the basal may need reducing. Having regular lows will lead to not recognising them. However I've had this happen and found I now recognising the low feeling low 4s. Simply by eliminating the hypos, the awareness should return, although it I as advised to run them slightly higher. Have you had info on basal testing. Thats usually the first thing to look at with regular hypos. If hypo within 2 hours of eating usually indicates bolus needs reducing. Regular 2 hour testing will help and if bloods 6~8 2 hours after eating with another 2 hours of the quick acting left there is an obvious hypo risk before next meal. Usually having a 20 carb snack at this point wil prevent it. Very hard with children due to unexpected activity.

Sent from the Diabetes Forum App

its more important to keep hypo awareness than avoid highs! and what do you class as high? personally yesterday i was at 26 and didnt realise untill I tested, why dont you try dropping a unit of insulin at every meal until you get into 9s/10s and try runing at that for a few days?

Shell1 said:

Hi my 9 year old has recently been in the 2's at school and fell asleep at her desk she told me that she had no signs like she does normally i just fell asleep .at home she get to lie 3's sometimes unaware.i rang my nurse before who said to run her sugars high for a week or two but didn't go into how ?can anyone help. We have tight control over Chloe's bloods her hba1c was 6.5 and we try to keep them under 9 .i don't her to lose hypo awareness but I'm scared to run high as the damage it does terrifies me .i hate her being high and it puts her in a bad mood too.should I adjust her ratios a little at a time so her bg goes up slightly it is that not how to do it


Sent from the Diabetes Forum App

Click to expand...

Hi

The reason why your daughter is having low bg levels with very little awareness is because you are controlling her bg levels too tightly which is the result of the 6.5% a1c. This is very common and affects loads of diabetics not just children. She probably would get better awareness if she was standing up instead of sitting down so Im not surprised that she just falls asleep. The way to sort this out is by altering her target bg level to being about 7mmol before she eats food and then allow for bg levels to rise to about 10mmol mid morning/mid afternoon and then hopefully they will then drop back to 6 or 7mmol again within the 4-5hrs acting time. Use a different insulin to carb ratio to sort it all out and don't worry yet about complications. Allow for a hba1c of about 6.9 to 7.1% and then things will be much better for her and for you too. She should be able to sense that she is going low with any luck.

Adult diabetics who use low carb food can achieve a good a1c without too many hypos but your daughter is only a child and to impose low carb food on her is ok in one sense but not ok in another as she will want to eat the same food as everyone else which in todays world is understandable so forget the low carb diet for now.


Hope that helps and all the best

It's frequent lows that are the cause of loss of awareness and it's more immediately dangerous than highs.

Sometimes the warning signs also become more subtle over time and it's harder to recognise them. In children this must make things difficult because they are often so involved in what they are doing that they may not notice them.
This is from quite a detailed article about hypo unawareness though some not relevant to children.

Research has shown that people who have hypoglycemia unawareness can become aware again of low blood sugars by avoiding frequent lows. Preventing all lows for two weeks resulted in increased symptoms of a low blood sugar and a return to nearly normal symptoms after 3 months.

Click to expand...

The author (John Walsh) also quotes a study where people raised their pre meal targets to 7.8mmol/l and regained awareness.
His advice is:

To reverse hypoglycemia unawareness, set your blood sugar targets higher, carefully adjust insulin doses to closely match your diet and exercise, and stay more alert to physical warnings for 48 hours following a first low blood sugar. Consider any blood sugar below 60 mg/dl (3.3 mmol) as serious and practice ways to avoid them. Use your records to predict when lows are likely to occur

Click to expand...

( written for adults and easier said than done, I know!)
http://www.diabetesnet.com/diabetes-con ... z0zikuymvL

If you have Ragnar Hanas's book there is a really good section on hypos and awareness . He describes the mechanism of awareness as a gluco-stat that can get stuck too low. It's well worth reading as an adult but your daughter might find that its written in a way that would help her understand.

Highs are scary and no-one wants to get to the dangerous levels associated with DKA nor to cause complications in the future. It's worth noting that in the DCCT (long term T1 trial) there was not a great deal of risk reduction once HbA1cs fell below about 7.5% However, the risk of severe hypoglycaemia (ie requiring help) increased as HbA1cs fell below 7% . Similarly, those people who are now getting Joslin 50 and 75 and even 80 year medals haven't uniformly had ultra low HbA1cs, the average is somewhere in the 7s. (and I doubt they had very tight control 50 years, let alone 70+ years ago)

Hi, please, be aware that your child is growing and perceptions of lows and highs tend to change a lot. I was diabetic since the age of 10 and gradually I had to recognise new signs for hypo & highs. Anyway my opinion (and please note it is only my opinion ) is that hba1c of 6.5 is too dangerous for a child or teenager because it usually means you are running from time to time dangerously low.
A hypo crisis can leave much more scars, also in term of self confidence. A hba1c of 7- 7.5 is not as bad as you may think for a child/ teenager.
As said I'm not a doctor but i have the experience of 34 years of diabetes and being diabetic since the age of ten.


Sent from the Diabetes Forum App

Hi, I know how scary this can be I am an adult with Type 1 and no hypo awareness. I lost mine 7 years ago and tried to regain it for 3 years. Running blood sugars a bit higher helps a lot of people. Some say Coffee can stimulate your awareness, but not sure this is suitable for 9 year old. I now have a Diabetic Alert Dog who tells me when I get to 4.0 as I was collapsing up to 4 times a week with very erratic falls in blood sugar levels. My Dognells me when I am dropping quickly and when my BG gets to 11.0 as well so I dont end up too high. Good luck hope you can get some control of it soon.