sugars keep dropping but no effect felt

[nanny1964]

sugars keep dropping and no effects felt

my grandson has type1, he is 9 years old, and recently his sugars are dropping below 2 and he doesnot feel any effects until they drop to 1.2, my daughter is out of her mind with worry which is understandable, can anybody give any advice please.
He is also due to go on a school trip, which involves staying away from home for 2 days, we are concerned that if his sugars drop while on an adventure it might go unoticed, we donot want to exclude him, as he is resenting being a diabetic as it is, any help/advice will be welcome, as he is the only diabetic in his school and around the area he lives.

 

[weeezer]

Re: sugars keep dropping and no effects felt

how worrying for you all

not an expert...but this has happened to me (t1) when my bg was running low alot, i started to lose my warning signs & i wouldn't realise i was having a hypo until i was in the 2s and all of a sudden was very confused & it was hard to deal with. this has improved since my bg has been running at a more realistic level, yes, with the odd higher reading, but i'd rather have that than horrid lows.

my little boy is 9, i know how pre-teen they are without diabetes to add to the situation.

if he goes on his trip he needs to be supervised & constantly checked re his levels...i think diabetes should always be in the background and not get in the way of life, but whilst these levels are so low he really does need to be monitored closely. we're always striving for low blood sugar levels, but sometimes need to run a bit higher to be safer.

good luck with this, i'm sure there is lots of advice coming your way xx

 

[Jen&Khaleb]

Re: sugars keep dropping and no effects felt

My son is 5 and seems to have some hypo awareness even though he also has a disability. He will ask for food if hypo and he seems restless in bed if either high or low. When he was younger he had no hypo awareness. Has your grandson had diabetes for long? You'd have to aim for higher levels to try and get some better hypo awareness but kids are reknowned for being busy and active and not recognising their symptoms early. Instead of aiming for levels between 4 and 8 it might be better to aim for levels between 6 and 12. While away on a camp I'd really be aiming to see more levels around the 10 mark if he is on needles and not on a pump. At night someone would need to get up and check his levels and he would need to be carefully monitored doing activities. A detailed plan needs writing up before he goes to camp and lots of hypo food sent with him. Many parents of kids with T1 go to camp with their kids or are allowed regular mobile phone contact. Trying to stop the lows depends on what regime he is using and how compliant he will be with regualr testing and carb counting.

 

[nanny1964]

Re: sugars keep dropping and no effects felt

thankyou for your replies, but the other problem is that if he does go on the trip, the teachers that monitor him at school will NOT be attending,the doctors at the hospital have recommended dropping his lunchtime insulin lower, to make him run low for a few weeks so that he will get used to feeling low,he has been diagnosed for 2 years now. He does his own injections and blood tests, he has taken it all on board and understands his diabetes, but the concern is that he just doesn't feel the effects.

We are just going to start carb counting, as we were not adviced to do this sooner, can anyone tell me what are the best scales to buy? and is it easy to do?, i understand it is necessary but just don't know where to start with carb counting

 

[catherinecherub]

Re: sugars keep dropping and no effects felt

I am hoping a Type1 will advise. It is the weekend and things are usually slower.

There is an online carb counting course that would be useful.
http://www.bdec-e-learning.com/

 

[nanny1964]

sugars keep dropping and no effects felt
by nanny1964 » Today, 10:11 am

my grandson has type1, he is 9 years old, and recently his sugars are dropping below 2 and he doesnot feel any effects until they drop to 1.2, my daughter is out of her mind with worry which is understandable, can anybody give any advice please.
He is also due to go on a school trip, which involves staying away from home for 2 days, we are concerned that if his sugars drop while on an adventure it might go unoticed, we donot want to exclude him, as he is resenting being a diabetic as it is, any help/advice will be welcome, as he is the only diabetic in his school and around the area he lives. He has been diagnosed for 2 years, he is on injections, he has taken the diabetes on board and understands it, but the low sugars are a worry, the hospital has also advised to lower his lunchtime insulin to let him run low for a few weeks so that he might be able to feel when he is low, he injects himself and does his own blood tests at school supervised by a teacher.
The other concern is that the teachers who supervise him in school will NOT be attending the trip, we have also been advised to start carb counting, can anyone tell us the best scales to get, and is this easy to do? we don't know where to start with the carb counting, but understand that it is important to do so.
nanny1964

Posts: 2
Joined: December 21st, 2010, 4:29 pm

 

[iHs]

Re: sugars keep dropping and no effects felt

Postby iHs » Sat Feb 11, 2012 3:32 pm
Hi

Unfortunately modern analogue and human insulin is well known for its hypo awareness effect on bg levels. Animal insulin offers better awareness although this is not set in stone .....

What I suggest is that frequent bg testing is done to find out exactly what time the bg level starts to change. It does seem as though too much bolus insulin is being given or if hypo is occuring mid afternoon, then it might be down to the basal insulin being too much and needs to be reduced down a mark or two. In the meantime, no harm at all in eating a small snack mid morning or mid afternoon as that helps to prevent hypos occuring before lunch or before eve meal.

If you can find out more about carb counting and using a ratio to figure out the correct amount of bolus, then that will help things quite a bit. Quite a lot of posts are on the forum. This is a good thread to read viewtopic.php?f=26&t=26614&p=246496&hilit=carb+ratios#p246496
Type 1 - using a pump since June 2010

Prevent complications - shut the gate before the cows get out or the bull gets in

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iHs

Posts: 1027
Joined: Sun Jun 08, 2008 5:18 pm

 

[iHs]

http://www.leedsth.nhs.uk/sites/diabete ... bcount.php

 

[AMBrennan]

A bit more information on hypo unawareness. An important addendum, the normal hormone response to low blood sugar is not present in hypo unaware individuals i.e. the problem is not being able to notice the symptoms but not having any symptoms at all.

The decision to lower his doses to let him run a bit higher for while is generally a good idea to restore hypo awareness, although the effectiveness will depend on what's causing the hypos (ask the consultant if it is possible to get a continuous glucose sensor for a week to pinpoint that).
Generally, if blood sugar is low after meals then the meal time insulin doses will have to be reduced; if pp blood glucose is OK combined with a pattern of lows then the basal dose will have to be reduced; finally, if physical activity ("adventure") leads to hypos then he'll either have to have snacks during such activity, or get an insulin pump (insulin release is reduced during physical activity in healthy people, which obviously cannot be achieved with ideally constant basal insulin)

Carb counting is useful - it allows one to eat more variable meals - but will not really solve the hypo problem. It might, in fact, be easier to stick with fixed meals until you can work out an insulin regime that will not result in frequent hypos. This can then be used as a starting point for carb counting (knowing how much insulin you need for the fixed meals allows you to work out how much you need for larger/smaller meals).

Whilst there are special scales with pre-programmed nutrition information for common foods I don't really think that there's much point in getting one (you'll still have to look up the codes for the food, rather than just being able to look at the label on the box).

As for the teachers, since your child is able to do all the testing and injections, I think that a fairly simple checklist would enable any teacher to supervise your child.

• Check BG before meals; if it's OK take X units of insulin, if it's high increase by Y u, if it's low decrease by Z u.
• Check after meals; if it's OK do nothing; if it's very high, give a correction dose of X u, if it's low give a snack.
• Check before physical activity, give a snack if not high
• Etc

 

[nanny1964]

thanks for the info, he does check his bloods as you said, the problem is he can have a reading of 8 then within an hour he has dropped to 2 or below, we can see the signs when he has dropped eg he gets very emotional and goes pale, our concern is that if he goes on the trip people that don't know him won't be able to read the sign of a hypo earlier enough.
A glucose sensor sounds like a good idea.
We have also talked to him about the pump, but unfortunately he is dead set against it.

 

[iHs]

thanks for the info, he does check his bloods as you said, the problem is he can have a reading of 8 then within an hour he has dropped to 2 or below, we can see the signs when he has dropped eg he gets very emotional and goes pale, our concern is that if he goes on the trip people that don't know him won't be able to read the sign of a hypo earlier enough.
A glucose sensor sounds like a good idea.
We have also talked to him about the pump, but unfortunately he is dead set against it.

When he had the reading of 8 on his meter, how much bolus insulin was injected and how much carb did he eat. Also what time of day was this reading taken? This does sound like way too much bolus insulin was injected as he shouldn't be going so hypo an hour later..

 

[CarbsRok]

Hiya,
Perhaps it would be a good idea to higher his levels for the trip away ie cut his background insulin for starters and also cut his meal time insulin. Give all staff a list of hypo symptons to watch for and install into his carer what needs to be done and what to watch for whilst he is away.

 

[nanny1964]

he has 9 novaraid in a morning 15 mins before breakfast 6.5 lunch time 8 tea time 11 levermir at 6pm
when he was reading 8 it was at 5pm he had 3 sausages mash small portion mash potato large portion veg and small portion gravy.... hour later he had a bath for 20 mins my daughter noticed signs he was becoming low she did a test and he was 2.1

 

[danielle0106]

hi mum,thanks for going on this site,found lots of info.
im going to write a new care plan for school,to treat 5 as low and 12 as high and to have more snacks at school and more blood tests, but his fingers r sore and hard skin is growing more harder

 

[iHs]

Hi Mum and Nan

Roughley the carb value of the meal mentioned is about 45g carb approx (5g carb for each sausage = 15g plus 20g for mash potatoe and then 10g for the large portion of veg. If 8 units was injected and the bg level 2hrs later was ok then the ratio would be about 1u for 6g carb. As it's not ok as he is hypo try using a ratio of 1u to 8g to see how much of a difference that makes. You can work your way up or down according to what bg results you get. It just means test test, write carb value down for each meal and then use ratios to work out yr insulin dose. You just divide the insulin into the carb eaten to get the ratio.

 

[Jen&Khaleb]

I'd be inclined to start giving 1 unit to every 15 gm carb and then work backwards. It is easy to give a small correction if needed and not as dangerous as having hypos. I'd also try and make meals with some portion of high gi food and some low gi food. So dinner might be sausages, small serve mash potato, veg and a slice of bread or piece of fruit after. You could even include some dessert once you can carb count correctly. If you are eating pizza or chips you might also use some trial and error to see if it is better to give insulin after eating as the fat in the food delays absorption.

The biggest drop with Novorapid occurs after 2 hours but there is about 20% still working for the next 2 or so hours after. Exercise also makes insulin work faster.

 

[microfazer]

switch to porcine insulins, problem solved. permanently.