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First waking Hypo - Advice

Penfold_Dad

Penfold_Dad

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Type of diabetes
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hi

My 4 year old daughter woke up this morning with her first waking hypo, tested at 3.3 on the meter. She was 10.6 at 3 in the morning so decreased rapidly over night. I gave her a few haribo which within 15 minutes brought her back up to 6.6 and she has just scoffed 3 weetabix with milk, approx 60g of carbs.

What do I do with the insulin now? Should I inject for the carbs straight away or let her come back up higher first?

Thanks
 
A difficult one with such a young child. I would think about her normal blood sugar after breakfast. Is she prone to going low after? Does she spike high very quickly? That would inform my choice.

If in doubt, always err on the side of caution. Whatever you choose to do, note how her blood sugar reacts so if it happens again you'll have a better idea of what to do. You might also want to speak to her diabetes team about that sudden fall in blood sugar during the night. If it was me, I'd watch out for a similar low tonight and maybe do some extra tests.

It's good she came back up quickly. I hope you have no more problems today :)
 
azure said:
A difficult one with such a young child. I would think about her normal blood sugar after breakfast. Is she prone to going low after? Does she spike high very quickly? That would inform my choice.

If in doubt, always err on the side of caution. Whatever you choose to do, note how her blood sugar reacts so if it happens again you'll have a better idea of what to do. You might also want to speak to her diabetes team about that sudden fall in blood sugar during the night. If it was me, I'd watch out for a similar low tonight and maybe do some extra tests.

It's good she came back up quickly. I hope you have no more problems today :)
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She spiked to 21.6 straight after even after offsetting the carbs with insulin. This is all very new to is so we have no real pattern yet. I'll test her again very shortly to see where we are at. She ate three Weetabix and a bowl of porridge with raisins which is good going for a 4 year old of only 14 kilos
 
Yes, a big breakfast : D Hypos sometimes do cause hunger, if that was more than she'd usually have.

Make sure she has plenty to drink with a blood sugar that high. Is her blood sugar coming down?
 
if you do not over correct on a hypo, then it should be fine to take insulin with food after. I do sometimes wake up almost hypo. I would eat 3 x jelly babies or drink 100ml lucozade and then perhaps half a banana or a 10gram oaty type biscuit. Once my sugars are back up to normal, Id take my insulin with my breakfast as normal. I would not take a correction dose.

At night, if I woke up at say 3am and was 10, I would not take a normal correction dose (maybe only .5 units). If i was say 12, I might only take 1 unit.

Also, what you need to take into account is.... in the morning when you wake up, Your body releases hormones to wake you up which also raises blood glucose levels so if you want to correct a hypo in the morning, perhaps only 2 jelly babies or 50ml lucozade.

How much insulin did you give her at 3am when she was 10.6?
 
by the way... I think its great that you are using this site for help. Its a huge learning curve to any family when a child is diagnosed as a type 1. It is hard but you will get there. Its not easy but once you get into a good routine, things will change.
 
Omnipod said:
if you do not over correct on a hypo, then it should be fine to take insulin with food after. I do sometimes wake up almost hypo. I would eat 3 x jelly babies or drink 100ml lucozade and then perhaps half a banana or a 10gram oaty type biscuit. Once my sugars are back up to normal, Id take my insulin with my breakfast as normal. I would not take a correction dose.

At night, if I woke up at say 3am and was 10, I would not take a normal correction dose (maybe only .5 units). If i was say 12, I might only take 1 unit.

Also, what you need to take into account is.... in the morning when you wake up, Your body releases hormones to wake you up which also raises blood glucose levels so if you want to correct a hypo in the morning, perhaps only 2 jelly babies or 50ml lucozade.

How much insulin did you give her at 3am when she was 10.6?
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I didn't give insulin at 3. 10.6 is still actually quite a low reading for us at the minute. I just tested again and she is 23.6. Bolus advice is another 1.5 according to the meter.

Her food intake is enormous at the minute. She lost quite a bit of weight before being diagnosed and is mostly hyper at the minute and is eating adult sized portions continuously
 
Oh... i m sorry. i thought you gave her a bolus at 3. OK.... if she dropped that much between 3am and waking up, then her background insulin is too much.
How much basal is she on? what time do you give it?

Insulin does make one eat.... especially if you are taking a bit more than you require. This tells me that her insulin doses could be a bit high.

how much insulin did you give with her breakfast and what time?
 
insulin on board works for up to 4 hours. Depending on what time you gave her the food and insulin..... Id not correct unless this test is at least 2 hours after
 
if its within 2 hours.... the best advice is water and activity. Id walk and drink water and my levels would come down.
 
Omnipod said:
Oh... i m sorry. i thought you gave her a bolus at 3. OK.... if she dropped that much between 3am and waking up, then her background insulin is too much.
How much basal is she on? what time do you give it?

Insulin does make one eat.... especially if you are taking a bit more than you require. This tells me that her insulin doses could be a bit high.

how much insulin did you give with her breakfast and what time?
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Her basal is 4.5 and we give it at 1900hrs

I gave her 3.0 novo rapid at 7.30 am which after her hypo just covered the carbs on the 1:25 ratio she is on. Please bear in mind she was only diagnosed Sunday 22nd November and we have only been carb counting since the start of this week. We did the carb counting course on Monday afternoon.

My inclination is that the basal is too high and the ratio is too low
 
Have you thought about doing the basal in the mornings where she is more active in the day and then at night when she is less active, the basal has already peaked and not so active?
Maybe reduce it to 4.

Carb ratios also vary throughout the day so you may find that her ratio is slightly higher in the morning due to what they call 'dawn phenomenon'

Have you spoken to many diabetic people in person or say on the phone? If you want to drop me a telephone call....then private message me for my number
 
Omnipod said:
also... being newly diagnosed.... have they told you about the honeymoon period?
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Yes we are aware she is in the honeymoon period which is why I'm guessing she is a bit all over the place. I know for a while her pancreas will be giving fluctuations of insulin but that is all I know really. Our diabetes specialist nurse has been really great and we are having to put a lot of trust in him for the time being as he is calculating our ratios and basal dosage.
 
Also as she is such a small girl for her age, she is one half of non identical girl twins who were born prematurely the ridiculous amount of food she is putting away has confused him slightly
 
@Penfold_Dad Shes's very close to diagnosis so it's not unusual for things to be very up and down at the moment. You'll gradually work out how her body reacts to food and insulin, and that will make things easier.

If her blood sugar is high a lot, then that will make her hungry too. It will be more difficult for her to put weight on with high sugars as she won't be able to 'use' the food she's eating.

It may be her insulin will need adjusting. If you keep good records of her food, insulin and blood sugar that'll help her team see patterns and get the best regime for her.
 
as long as you have a good team who you are happy with. My best advise is to get a Dexcom cgm which will help with peace of mind and give you a much better understanding of food and insulin. And then a DAFNE course. The two best solutions for diabetes.

I hope her levels are coming down nicely.
 
If she has a slow acting night time insulin dose I would reduce that. My daughter injects Lantus at night as a background slow acting and Novarapid with snacks and meals.

.... just noticed that this has already been suggested to you, reduce basal.
 
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Omnipod said:
if you do not over correct on a hypo, then it should be fine to take insulin with food after. I do sometimes wake up almost hypo. I would eat 3 x jelly babies or drink 100ml lucozade and then perhaps half a banana or a 10gram oaty type biscuit. Once my sugars are back up to normal, Id take my insulin with my breakfast as normal. I would not take a correction dose.

At night, if I woke up at say 3am and was 10, I would not take a normal correction dose (maybe only .5 units). If i was say 12, I might only take 1 unit.

Also, what you need to take into account is.... in the morning when you wake up, Your body releases hormones to wake you up which also raises blood glucose levels so if you want to correct a hypo in the morning, perhaps only 2 jelly babies or 50ml lucozade.

How much insulin did you give her at 3am when she was 10.6?
Click to expand...

I was told by our team not to let my daughter go to bed lower than 10. Apparently if you go low at night your liver can squirt out sugars making you high in the morning. Therefore I wouldn't give any correction in the night being at 10.6.
 
Thanks for the reply Elena

If she is under 10 just before bed what does she snack on? We were thinking something like cashew nuts which should be slow release as an ideal snack
 
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