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Toddler - Low Bg after eating

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Fennecb

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Hi all, my daughter was diagnosed in late Jan with T1. Recently we have noticed that after most meals her BG drops below 4mmol. She had prior to this been in target range for 85%. She had been on 1u levemir in the day which we’ve just adjusted to 0.5u on advice for diabetic team. Her B/L/D ratios have also been altered.

For example this morning she was 3.9mmol upon waking. 8:15am She has two slices seeded toast with scrambled egg (21.4g carbs) - 1u novo rapid. At 9:40am she was 9.2mmol but by 10:45am she was 3.7mmol. This happens after most meals now.

Does anyone have a theory or advice? It’s rather concerning.

thanks so much
 
Fennecb said:
Hi all, my daughter was diagnosed in late Jan with T1. Recently we have noticed that after most meals her BG drops below 4mmol. She had prior to this been in target range for 85%. She had been on 1u levemir in the day which we’ve just adjusted to 0.5u on advice for diabetic team. Her B/L/D ratios have also been altered.

For example this morning she was 3.9mmol upon waking. 8:15am She has two slices seeded toast with scrambled egg (21.4g carbs) - 1u novo rapid. At 9:40am she was 9.2mmol but by 10:45am she was 3.7mmol. This happens after most meals now.

Does anyone have a theory or advice? It’s rather concerning.

thanks so much
Click to expand...

Hi,

Welcome to the forum.

What sort of test numbers are you seeing prior to the meals?
 
What are you using to test her blood sugars?
If you are using Libre, I recommend checking with finger prick as Libre can be inaccurate round 4mmol/l.

Do you prebolus? If so, it may be worthwhile dosing later as it may be that the insulin is becoming active before the carbs are broken down.
Some injection sites are faster to absorb.
 
Fennecb said:
Normally around 5mmol
Click to expand...

Hmm personally, i would start looking at the basal insulin first & see what that is doing?
The kid maybe dropping prior to eating & any digestion of food..? Then the Novorapid kicks in & drops her again..
https://www.mysugr.com/en/blog/basal-rate-testing/

With regards to the possibility that your child uses a sensor to monitor her BG levels..
They don't seem to recommend it being used on anyone under the age of 4. https://www.freestyle.abbott/us-en/products/freestyle-libre-2.html
 
She may still be releasing a little of her own insulin so in addition to reducing her basal insulin (levemir) you may need to adjust her bolus mealtime insulin. Do you have a child's pen so that you can do tiny adjustments? For example if you are dosing 0.5 units for 10g carbs as per your breakfast example try 0.4untis per 10 g or 0.8 for her current breakfast. Remember you are trying to get her landing around 5-7 bgs after 4 hours (the active time of the novorapid I think). It is definitely an art and not a science because a cold or not finishing her crusts could change the result either way so don't get too hung up on the maths.
There's a school of thought that kids and their families can go low carb as a great way fo getting much smoother blood sugars and better health for the family overall. The FB group is called Type One Grit if you are interested and its all based upon Dr Bernstein (diagnosed diabetic himself in 1948 aged 12).

The other thing is that although under 4.0 is a hypo and should be treated as such especially if there's a vertical or diagonal line on the FSL , your daughter may not be having symptoms and the important thing is not to over treat or she'll bounce up in the wrong direction or get hooked on the sweets you may use (speaking from my own diabetic childhood here).
It sounds as if she's generally doing well though and that you're dealing well with the curve ball of a type 1 diagnosis!?
 
Thanks everyone.

We use both blood sticks and the Libre2 in combination. I personally don’t find the Libre to be that accurate so we still finger prick a fair bit.

It’s most definitely a juggling act right now and we feel like we ate swinging side to side. The hospital did talk about the ‘honeymoon’ phase but said it’s longevity is unknown.

We have pens for Levemir and Novorapid but they only go up in 0.5u increments. We give 0.5u levemir morning and night now as she was on 1u in day and 0.5u at night.

Her ratios for breakfast, lunch and dinner seems to be adjusted by the doctors every two weeks at present.

As a family we are sadly living a ‘carb’ heavy diet but she is fairly fussy.
 
Fennecb said:
We use both blood sticks and the Libre2 in combination. I personally don’t find the Libre to be that accurate so we still finger prick a fair bit.
Click to expand...

If it's any help to you. There are some well tested & trusted 3rd party apps for the libre that can be calibrated?
However, the BG meter will always have a 15/20 minute lag. What can be done is either scan, wait 20 than BG check.
Or with the app I use reading out the graph in a series of linear dots every 5 minutes. I click on one reprisenting 15 minutes ago. (With a CGM set up.) Then test. I'm normally happy if they are within 0.6mmol.
Preferably the calibration check should be done on a relative stable straight line BG graph.?
 
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