hypo after every meal.....

[jonesy]

at the moment my son is having a hypo pretty much after every meal. i have started carb counting, using a ratio of 1/20 or 1/25 (still experimenting a bit here). so, a lot of meals are only 3 units of novorapid. however within an hour after virtually every meal he has a hypo, going as low as 2.2, usually 3.0 - 3.5. but, then during the second hour after his meal, his bg rises, sometimes to double figures.
i need to explain...if his hypo is not below 3.00 i treat with minimal glucose and no carb snack (1 or 2 glucose tabs). if it is 3.5 i don't treat and get him to rest for a few mins and no carb snack, as i know this second hour rise in bg is coming.
i am new to all this but, could it be possible that my son (9 year old) could be taking over an hour to two hours plus to break down his carbs into glucose?? this would explain the hypos maybe. if his insulin is acting way before there is any glucose in his blood then surely this would happen, with a surge an hour or so later when the glucose comes.

is that a crazy idea??



jonesy.

 

[NickW]

Hi jonesy,

Sorry to hear your son is having these problems.

To be honest there could be a few different explanations. It could be that the ratio is too high (i.e. he's taking too much insulin), which is causing the hypo; the later rise could be caused because the liver will release glucose when he goes hypo to try to combat it, and it often over-compensates.

Or it could be that the glucose is being released slowly and the insulin is acting quickly, as you suggest. The type of carbohydrate (high-GI vs. low-GI )and what it's eaten with can affect this massively (e.g. eating fat with any source of carbohydrate will slow down absorption, sometimes significantly).

Or it could simply be that you need to give the injection slightly later than you currently do, so the food has slightly longer to get into his system before the insulin kicks in.

Then of course, if your son is newly diagnosed he could still have some pancreatic function which can confound things - he might still be producing a little bit of his own insulin.

As you know, it's hard because we have a very "blunt tool" in injected insulin, and we're trying to use it to treat a very complex issue. Sadly it'll be experimentation that will ultimately give you the answers. One thing to consider is whether it might be easier with less carbs in his meals; not necessarily a low-carb diet, but just slightly reducing them to say a maximum of 50g per meal (or even lower). The reason I suggest this is that you're playing with smaller numbers; if he eats fewer carbs his blood sugar will change by less, and you'll inject less insulin which will also change his blood sugar less. Like I say I'm NOT suggesting a full-on low-carb diet, and it's probably important not to make too big a deal of it and turning meals into a huge issue; but reducing carb portions and upping protein and fat might help out.

Sorry I can't give any hard-and-fast answers, but I hope this helps give some ideas.

Cheers,
Nick.

 

[jonesy]

bit worried about giving too little amount of carbs as the doctors said kids still need plenty of carbs while growing.
i thought a carb count of 75g was quite low for a kid's meal....no?

 

[SophiaW]

jonesy, I'm not sure how old your son is, but my daughter who is an active 8 year old has about 40-50g carbs each for breakfast and lunch and about 60g carbs for her evening meal. She also has slow acting carb snacks before and if needed after exercise. An older child I'm sure would need more than this. With each meal I make sure a good portion of the carbs are a slow release type but there is usually something more quick acting too - kids yoghurts seem to have quite a bit of sugars in them but I keep to the 50g pots so it's a small amount. Or she might have a small glass of fruit juice or milk with a meal. I'd be reluctant to reduce the number of carbs in a meal if your son is eating what he's used to and he's healthy and active. I've always maintained that the insulin should be adjusted to fit with our usual healthy diet and not the other way around.

If your son is still in the honeymoon period then I think the lows will be down to him still producing a bit of insulin himself. And quite possibly the high later on is a rebound effect. I would try lowering the amount of insulin he takes with each meal, i.e. adjust your carb ratio, and see how that affects things. It's just my opinion and I'm by no means an expert but that's where I'd start. Also, for us anything under a reading of 4.0 mmol is a hypo and we treat it accordingly. I'm not sure I'd leave a reading of 3.5 mmol or lower untreated.

 

[jonesy]

saw his consultant today. we're going to a ratio of 1/30 and dropping his levimer to 5 units.

btw...he is 9 and very active.

 

[NickW]

Hi jonesy

I don't have any direct experience of T1 in children, so you're wise to defer to others with more experience. My comments were based on the fact that 75g or more per meal, assuming 3 meals per day and maybe a small snack or two, will mean something like 300g arbs per day - that's a lot for anyone, child or adult. For a 9 year old it's likely to be 65% of total calories, which again is a very high carb diet.

As I say, I wouldn't suggest a low carb approach, but I would have thought a lower amount might help with the more severe swings. 50g per meal is still 150g per day; and as long as you're careful to add in a little more protein and fat to account for the calories, I can't see how that can possibly be too few carbs for your son's health. It's at the upper end of what most adults would need to be honest.

With all that said, I'll repeat again that I'm not a doctor and don't have a diabetic child myself, this is all just opinion and I certainly don't mean to push you into anything - just trying to give an alternative perspective. Whatever you do, it sounds like you're taking great care of your son and monitoring the situation, which is the key thing - and I hope your changes to the dosages helps his control!

All the best,
Nick.

 

[kegstore]

Hi jonesy,

I also go with the honeymoon period explanation which I know is just going to be frustrating for you. Until this settles down though you're going to find it very difficult to maintain good effective control, as the goal posts are moving all the time.

Anything below 4 is going to be a hypo and should be treated as such. Getting as low as 2 will most likely prompt the liver to release glycogen, which drastically raises bg levels - the classic "liver dump". Then it becomes difficult to know whether the high reading is because of that or your treatment of the hypo.

The next advice may sound a bit odd, and I don't know whether everyone will agree, but it worked for me when I was having great difficulty establishing initial levels with my pump. I was having a similar rollercoaster ride with bg levels, so decided to run my levels a bit higher than I would normally, just for a few weeks, then bring the target down slowly. The damage caused by "running high" for a relatively short period of time will be minimal, and the benefit very high as you will feel more in control and not fire-fighting all the time. I'm not suggesting crazy levels, but also appreciate this might go against everything you've been taught!

Hope things settle down for you both soon.

All the best, Jo

 

[Shazza]

Hi I,m new to all this as well but was experiencing up and down readings with my 11yr old a few weeks ago, I reduced his insulin by a few units and his reading have settled down. I carb count and try and give him about 170g carbs per day, usually dinner is about 50g.

Hope his levels settle down as I know its very worrying

 

[jonesy]

kegstore...that's kinda what we're gonna try. chenged his ratio to 1/30 now and gonna go from there. right now i'd rather see him high than low.

thanks jonesy

 

[suzi]

Hi Jonesy,
May i suggest injecting your son after his meal to see if it makes a difference, my son Andrew is nearly 11 and we find when you inject afterwards at least you know exactly what hes eaten.
In the early days i found it hard injecting before, carb counting, then finding he'd only ate half his meal, then having to top him up with fruit juice to stop him having a hypo.
I know its a struggle to get the figures right and carb count and all children act differently to their foods, their certainly not all text book cases.
It does get easier, the only thing you can do is experiment with his ratios and test often,
Good luck and take care,
Suzi x

 

[jonesy]

can anyone tell me what is recommended carb intake for a very active 9 yr old boy?

100? 150? 175+?

 

[catherinecherub]

Hi jonesey,

I think you need professional advice on this one unless someone else on the forum has an active 9 year old with Type 1 diabetes.
Carb amounts that children require to grow and thrive can be so different to adults that have completed the growing process.

Catherine.

 

[jonesy]

haha.....'professional' advice is not always that helpful i've found. can be a bit vague at times!

 

[suzi]

Hi Jonsey,
I honestly don't know what the actual carb count for a growing 9yr old boy is, and Andrews an active 10 1/2yr old, whos been diabetic for nearly 4yrs. As long as he's thriving, eating healthy i wouldn't concern yourself on how many carbs a 9yr old needs. Yes it is good to have meals that aren't over laden with carbs as you'll find your feeding the insulin, but then again neither do you have to have carbs with every meal. We've discovered that a carb free meal still requires a few units of insulin, don't ask me why, it just works. As long as he's eating and not constantly hungry you'll know your doing good, especially when its along with good bs numbers.
Suzi x

 

[leggott]

Hi,

Sorry to hear about all your son's hypo's. Hopefully be adjusting your ratios you will get higher readings. When you make the adjustments, just do one thing at a time and leave it a few days. if you make too many changes at once, it is difficult to know which thing was the one that worked. I would suggest doing a blood test after 3 hours of eating. If the levels are still falling, this would suggest that the levemir is a little on the high side.

As far as carb intake requirements are concerned, check this out http://www.igd.com/index.asp?id=1&fid=5 ... 62&cid=447

The recommended carb intake for a child of 9 is 220grams a day.

Good luck

Leggott.

 

[Jen&Khaleb]

Khaleb is nearly 3 (weighs about 15kg) and eats at least 100gr carb/day. He would have somewhere between .9 and 1.2 units of insulin/kilo. I'd go with the advice to run a bit above normal range and bring the levels down slowly rather than see-sawing. Trial and error is hard when success isn't gained quickly but with diabetes there isn't really any other way.

All the best beating those hypos. Jen.

 

[jonesy]

thanks everyone....

saw his consultant...we are going to a ratio of 1/30 and dropping his levimir from 6 to 5.

fingers crossed!

jonesy

 

[AnneK]

My Son is 9 and also type 1 Diabetic. I have never been told to reduce his carb intake in anyway merely inject the appropriate amount of Insulin. He test before dinner and if he has a low reading then he eats first and injects afterwards. He to is honeymooning and it can be frustrating at times but we plod on and hope for the best.

We are working on the European measurements so it's all confusing....

But if you want to compare notes as we both have 9 year old boys i'd be more than happy. i'm still adjusting to all this and at times question the diagnosis.....

 

[sugar2]

Not saying this is is right, merely posting for a comparison.

When I was a very active 9 year old girl, it was the old days, when we couldn't adust insulin, and therfore had to control the amount of carbohydrate we ate. I can not remember my insulin, exceptthat it was twice a day...but my carb intake was ingrained! I had

breakfast 30 gr
snack 10grm
lunch 30 grm
snack 10 grm
tea 35 grm
supper 10grm

I am not suggesting that this is ideal, and it certainly 30 years out of date, but looking at this, it does suggest that 75grm per meal is a lot

Hope the new regime works!

 

[dot]

My Son is 9 and also type 1 Diabetic. I have never been told to reduce his carb intake in anyway merely inject the appropriate amount of Insulin.

Same here. Day after diagnosis when my lad was still rather scared and worried about the fact that he would never be able to do anything again..ever..., the paediatric diabetic consultant told him that he didn't really need to change anything, other than trying to avoid snacking. He could eat whatever he wanted. We haven't been given any advice on carb counting either.

The diabetic nurse looks at the readings and she set a basic dosage programme from that. We do adjust the dose abit though now and then if necessary.

While they are growing I think that I would be very wary of trying to control their diets too much.