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Initial Treatment Of 14 Month Old

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Violette68

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Hi everyone, I am new here but not new to Diabetic babies, my own son having been diagnosed at 14 months. I have come here with a question regarding my little grandson who is has also just been diagnosed at 14 months.

The doctor has apparently said that his sugar level needs to be lowered very slowly so that there is no swelling of the brain which can sometimes occur in very young Diabetes patients when the level is lowered too quickly. Does anyone have any experience with this or knowledge of it?

I am a little concerned that they have left him running high (mid to high 20's) for several days though.

Thank you.
 
Sorry to hear of the diagnosis.......

I have no experience of this unfortunately.......I would say that coming down slowly is probably a good idea but mid to high twenties is still up there in the very high range.....so, seems a bit off....
 
novorapidboi26 said:
Sorry to hear of the diagnosis.......

I have no experience of this unfortunately.......I would say that coming down slowly is probably a good idea but mid to high twenties is still up there in the very high range.....so, seems a bit off....
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Thank you- yes it was a shock especially with the age being almost exactly the same but I am feeling a bit better about things now, knowing that they will start on the pump very soon- they will not have the hell that we did with out little guy for the majority of his childhood.

However, for the moment, yes, it seems weird to me to go SO slow with the insulin as to take 3 days to get it at least a bit lower - I had not heard of this potential brain swelling so I don't know what to make of it. I can't seem to find anything on the internet about yet either.
 
Hi @Violette68 ,

Welcome to the forum.

Coming down steady after a period of high sugars makes sense to me.. Sometimes, issues may arise with a rapid lowering of BG? (Think of it like a "decompression".) Mainly from what I've heard this can manifest with the eyes?

Though, leaving the little guy running in the 20s needs addressing with his HCPs..

I'll tag in @Juicyj @helensaramay for a few thoughts..
 
Ok, I changed my search terms and have indeed found this following information which seems to confirm what we thought we heard the doctor say ...

"Cerebral edema is the leading cause of death in children presenting in diabetic ketoacidosis and occurs in 0.2 to 1% of cases. The osmolar gradient caused by the high blood glucose results in water shift from the intracelluar fluid (ICF) to the extracellular fluid (ECF) space and contraction of cell volume. Correction with insulin and intravenous fluids can result in a rapid reduction in effective osmolarity, reversal of the fluid shift and the development of cerebral edema. The goals for treatment should be a combination of intravenous fluid and insulin that results in a gradual reduction of the effective osmolarity over a 36- to 48-hour period, thereby avoiding rapid expansion of the ICF compartment and brain swelling." (ncbi.nlm.nih.gov)
 
I was diagnosed last year at the age of 43 and because my hba1c was so high and bloods were running >30 they brought me down slowly. In the first 48 hours they told me to be under 20, then for the following 2 weeks to aim for around 10.

Given I'm an adult and how concerned they were I imagine the effects would be a lot more severe for a baby. Are you able to monitor ketones?
 
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