Two different 'types' of blood sugar readings?

[moopf]

Hi,

My 9 year old son was diagnosed with Type 1 in January so we're very new to all this but we've been trying to keep on top of it and so far it's been going OK. He had his first Hb1Ac last month which was 6.8% which we were pretty happy with. His honeymoon started coming to a close around 4-5 weeks ago, sooner than we hoped, but it's such a relatively small stage in his life with Diabetes we've tried not to get too attached to it. He's on multiple injections - before meals and longer acting each day.

Anyway, to the point. We want to know if we're going mad or if this is something that other people see. Basically we've come to think about blood sugar readings in two different ways - one type that we know is stable, where there isn't going to be a huge drop, and another that seems much more fragile and prone to dropping. This is something we've seen throughout the last 4 months. Yesterday was a good case in point - he had his tea at 4.30pm, then took part in a local festival from 5.30pm for 2 hours (lots of walking around). He had 8g carbs in biscuits at about 6pm, just to give him a little bit more to keep going on. By the end of things he was 9.5 which, whilst a little high, wasn't of any concern (we'd purposefully given him a ratio with his tea to keep him on the higher end, rather than have him hypo and ruin his fun). Then, as we always do, we tested him just before bed, and he'd shot up to 14.3 - this can happen with moderate exercise, as we know. But this is the reading that we understand as a fragile one (it's the only way I can explain it). We didn't want to take the risk of giving him insulin because of this, and also didn't want to give him any extra carbs. So he went to bed. Within an hour he was 6.6 (we tested again then because we thought it would prove to be such a fragile reading). We woke him up to give him some milk and everything was fine after that.

Like I say, this is something that we see relatively often, especially 3-4 hours after a meal. Do other people come to understand blood sugar readings as different 'types' like this? We try not to treat either way if we feel it's one like this and instead test again within half an hour or so just to confirm. Insulin would obviously make him crash a lot and, giving carbs at this point we're unsure whether that would bolster the high and cause him to go even higher or just offset the drop that is likely coming.

We're just trying to make sense of things, really, and understand whether what we're seeing is something that others understand, or if we're way off in thinking like this.

Thanks,

Gareth

 

[onthegow]

Hi Gareth.

I have many readings like this. I am an adult and it baffles the hell out of me. Like you if I am high before bed I use to give myself insulin but that caused a low at around 2am. I have also left the high untreated but again at 2am lows again. I find I have to balance my sugars at or near 10pm or I play roulette throughout the night. I have had the sugars under some control but today out of nowhere 18.8 strange reading. I corrected the amount I am meant to give myself but it only took a fraction off the 18.8. It's difficult I'm sure when you are doing this for someone else. I have resulted to injecting on how I feel rather than chasing carbs. I do of course measure my carbs but end up checking lots within that 4 hr period especially when it's close to bed time. What I am trying to say in a long winded way is yes I have had times like you describe I think you are dealing with it perfectly.

 

[michaeldavid]

I have been diabetic, type 1, for 30 years this very month. (I've been reflecting on that today; hence the length of this post.) And I'm at least as healthy now as I have ever been, or possibly more so.

You say your son's blood-sugar "shot up to 14.3", and then you write: "this can happen with moderate exercise, as we know." But you've got things precisely back to front. Any exercise at all will tend to LOWER your son's blood-sugar: the more exercise he takes, the more his blood-sugar will be burnt up. 

There is only one kind of blood-sugar reading: the varying effects you have noted will be down to both the insulin (or insulins) your son is taking, and the food he has eaten during the course of the day. (A large amount of cheese during the day, for example, would be sure to push my blood-sugar up high in the evening; a large amount of animal fat is not good for anyone.)

My control is certainly unorthodox. But the orthodoxy is seriously at fault. And in part, but only in part, I believe this is a function of the normal modern diet - diabetic or otherwise. (Doctors tend to eat much the same as everyone else, after all.) 

I don't have universal expertise, but I know the effects of the insulin which I take: the effect over time (plotted on a graph) describes a kind of bell-curve. The effect of the Actrapid I take runs out, for me, after around thirteen hours; and the effect of the Novorapid runs out after around eight hours.

If you click on my username, you can see what insulin I take and when I take it: I engineer it so that the respective effects of the two fast-acting insulins both run out together, at midnight. (Naturally, your son's metabolism will have its own characteristics; and his insulin will come with a slip of paper which tells the length of time that it takes effect.)

When I check my blood-sugar at 11.00pm, then - provided I haven't eaten anything during the evening that's only slowly digested - I know (by experience) that my blood-sugar will go down by a further 2mmol/l by 12.00pm, whatever was the reading taken at 11.00pm. And if my blood-sugar is 4mmol/l at 11.00pm, then I know (by experience) that I should eat just one half a slice of the co-op's wholemeal, wheat bread. (The co-op's bread is a regular size, so I know the carbohydrate value is always more-or-less the same.)

I take a very small amount of Insulatard at 11.00pm, which prevents my blood-sugar from rising too much during the course of the night. (I can bump that up a little if my blood-sugar is higher than 6mmol/l at 11.00pm; but I won't bother with the details of that here - your son could just do some vigorous press-ups!) The Insulatard, then, will be the only insulin that's operating within my system during the night. And I can go to sleep knowing that I'm safe.

Regarding my diet, I DON'T HAVE TO WEIGH OR CALCULATE ANYTHING. The obsession with weighing and calculating carbohydrates is what I find most perverse and unreasonable about the orthodox method of control; it's especially unreasonable for children.

I emphasise the importance of eating RYE BREAD most strongly of all. For it's very slowly digested, and so has a moderating effect on the blood-sugar: more than anything else, this prevents me being caught out by a hypo. (I eat rye bread throughout the day, until 4.00pm; and I MUST THEN STOP eating rye, or my blood-sugar is sure to go high later in the evening.)

I have described my dietary regimen in the 'Soapbox - Have Your Say' section of this website: you'll find a fairly lengthy description in the section thread entitled 'Test Strips' - I posted it just a few days ago.

Equally crucially, I test my blood-sugar around 15-20 times per day. But I promise you this is no big deal. (And please, please don't bother with the blasted spring-loaded gadget - one can just use the bare lancet: that's simpler, quicker, gentler, and far more compact to carry around.) Most important in this regard is the availability of the highly economical, visually read testing strips: the only practical ones available are BETACHEK VISUAL. (You can stick the lancet, plus a spare, inside the tube of testing sticks; I use each lancet umpteen times before it starts to get blunt.)

Betachek Visual are on the UK Drug Tariff, but there is currently no UK distributor.

Using a good pair of scissors, and with good eyesight, each of the visually read strips can be cut into five. (The cost to the NHS works out at around 2p per test, which is peanuts alongside the exorbitant cost of electronic testing sticks, with the cumbersome meter - obviously, the electronic sticks cannot be cut with scissors.) Betachek Visual are highly dependable and very accurate for anything below 7mmol/l, which is certainly where my blood-sugar is most of the time.

My blood-sugar often goes slightly low during the course of the day. But SO LONG AS I'VE BEEN EATING RYE (rye bread, or rye flakes, or rye whatever), I promise you that is not a problem. (That's how I keep my HbA1c readings so very low.) But naturally, you will want to be highly cautious about that.

Because of my control, I can expect to have no long-term diabetic complications whatsoever. And if he's careful, your son can expect the same. I wish I'd discovered the beneficial effects of eating rye earlier. Nobody told me about it; I had to discover it for myself.

I think you won't find any medical professional who will endorse what I've recommended here. You will have to try it for yourself. But if you're careful, there will be no risk in trying.

So there are two crucial elements: 1. Eating rye bread (or rye whatever) consistently throughout the morning and the early afternoon (but be careful: not too much - or his blood-sugar will go high in the evening); 2. As much blood-sugar testing as you like, and still more.

Also, I think it's very likely that a change to your son's insulin will be appropriate. And for that you will need to show your doctor what I've written here (prepare yourself for medical protestation), and ask him or her about a change of the insulin regimen.

 

[moopf]

Hi onthegow and michaeldavid and thank you both for your replies. michaeldavid, there's a lot to take in on your post and thank you for taking the time to write such a full explanation of your regimen. I'm sure there are things (like rye bread) that we'll definitely give a go, that sounds like something that could be useful and definitely worth a try.

I think everything is complicated to some degree with children due to the effect of hormones and just the act of growing so it's difficult to know why something happens when so much is going on in their bodies at this time of life anyway.

 

[David147]

Home glucose meters are fun, aren't they? In truth, most glucose meters are accurate enough for our purposes - testing, not diagnosis. Unfortunately, though, this variability could be considered totally within the meter's normal range of accuracy.

The reality is that, if you test your five fingers on your right hand one minute apart, you'll probably get five different readings. Some may be close; some may be 30 points off.

You should call your meter company to complain, though. I did this once for a 40-point discrepancy and the woman over the phone told me that it was within the meter's range and there was nothing she could do.

Because you're a Type 1 and on insulin, I understand why you want to pinpoint the number as close as you can; however, that's just impossible. Unless you have reason to believe your first number is inaccurate, go with the first reading you see. Or you could go crazy like I do, test a third time, and then average them.

Also, blood sugar is constantly changing. One reading is just an isolated moment in time.