Our daughter’s T1 presented fast and furious. She was sick on a Thursday 9/24 with flu like symptoms and by Saturday in a full DKA state BS of 1,343 and her BOB (Keytone) a 15. Her recovery was swift and we had exceptional care at Seattle Children’s Hospital. She seems to have bounced back, however her BS has remained high 250-300’s. She is getting her daily Lantis just increased from 19 to 22 and her Humalog ratio @ 12. Last night was her first time having a low 78 BS, and I am wondering if this is something we should be worried with. I had her sleep in my bed. I don’t want to create a fearful environment for her, however I/we are new to T1 and searching for any help along the way.
Hi there. I can totally relate. My son is newly diagnosed as well (September 10, 2016). We are also in the Seattle area, except we were seen at Mary Bridge. We were home from the hospital on 9/13. When we first got home we had a lot of 200’s and a few 300’s but we kept at it and the Friday before last we went into some kind of BS dream where everything was perfect for about five days. Then last Wednesday we headed off into low land and have seen quite a few low blood sugars (last Thursday he even had a 48 at school). When we first got home we were at 8 units Lantus then were adjusted to 9, so we have decreased lantus back to 8 units and increased carb to food ratio we are currently 18 to 1, but when we first got home we were 15 to 1 and then moved to 12 to 1 for dinner only. If your daughter is having lows then I would call her endo clinic an discuss reducing lantus or increase of carb ratio based on what time of day you are seeing the lows. The endo nurses are there to help you adjust. When you call just have all your numbers handy and what I have been doing this last week or so when I see a blood sugar below 82 is give my son a free 15 carb snack such as a small apple, or some crackers. That seems to help get him back up and as a matter of fact I have a message in to our endo to see if his lantus needs to be reduced again. If he is running really low I have been doing a 20 to 1 carb ratio based on my own judgement. From what I understand our kids may be going through a honeymoon period where there are still some cells that are producing small amounts of insulin in the body and have not been killed off by the immune system yet. I think that is what is going on with my son right now. Happy to talk any time as it seems like we have a very similar circumstance.
I tried to reply but have not used this site a lot so I have no idea if it went through since I did not see my reply here after I submitted it. Anyway my son was just also diagnosed T1 and we have been home since 9/13. We are also in the Seattle area and were seen at Mary Bridge. When we were fist home we went through a period of higher BS (200’s and a few 300’s). Then we had about 5 days of really stable numbers and then starting last Wednesday we started to see a lot of lows. He even had a 48 last Thursday AT SCHOOL talk about terrifying. Anyway I would suggest to call your endo office to see if lantus or carb ratios need adjustments. We have adjusted my son’s a few times since being home and I have another call in to see about adjusting either lantus or carbs further (we are at 8 units of Lantus and an either 18 to 1 or 20 to 1 carb ratio). Just make sure you have your numbers to refer to and the endo nurses can help you adjust lantus or carbs if your daughter is running low. It may be our kids are in the honeymoon phase where there are a few lingering cells still producing small amounts of insulin.
Appreciate your reply. It’s those unknown’s that are scary. Very new to T1D. Just gathering as much feedback as we can at this stage. Thanks
The unknowns are very scary I totally understand I have probably never been more stressed, sleep deprived or nerve wracked being a parent until now. We are really new too and I just started researching pumps as well. I think I have it narrowed down to two so I am happy about that. I don’t know if this helps you but when I test my son before bed and he is in the 70’s, 80’s or 90’s I give him about 15 carbs with no correction before sleep. Usually one small apple does the trick or 6 ritz crackers are about 12 carbs. Our office told us for sleeping being around 100 is ideal. After the snack I wait about 15 min and make sure he has come back up. Also the glucose tabs at the drug store are really great. They are about 4g of sugar and are very fast acting. I got a big bottle for under $10.00. Message me any time. It is always helpful to support each other in this T1 journey.
I can imagine that you must be quite stressed and continually on edge; also that you may be more stressed than your daughter. It will get better. I know that as my BG starts going down my wife still gets more excited than I because I keep telling her that “… I’m OK”; and we’ve been married for only 50 years.
My experience has been that I tend to ‘go low’ after my BG has been elevated for several hours. There are many, many reasons why our body glucose levels fluctuate and often it is often difficult knowing the why. True that activity, foods and insulin in various combinations can cause BG to increase or decrease but a key factor is the timing of these three - add to that stress, hormones and excitement. Your daughter’s low could have been caused by what is called “insulin stacking”; she may have tried correcting a high reading y using a correction bolus several hours previously and the effect of that kicked in later than expected. That is only one hypothesis.
When coaching people with T1, I often say that this wonderful condition is a 24/L [“L” = lifetime] game. That is, before I take a meal bolus, or correction, I not only calculate carbs, properly apply the insulin / carb ratio for that time of day, but also ask myself what I have done or eaten for the previous 12 hours and what I intend to do during the next several hours. There is a mice flowchart that has the 37 decisions, some humorous, that must be considered before taking insulin.
Best wishes for your daughter and for you; don’t hesitate to ask any questions and be sure to share your experiences and wisdom with others. We all need support.
I understand exactly what your going through I have been a T1D for 6 years myself, and when I was first diagnosed I remember a lot of highs and lows (even to this day I have those days). I thought under 70mg/dl was low? Maybe you have a different sliding scale.
If my bs is not under 70 I will not take anything to eat at night, because usually it will spike at about 0700. The best way to deal with low bs is to follow the rules. 15 carbs, every 15 minutes until it is above your bs goal. This works wonders for me! Especially when its really low, like in the 40’s and 50’s I like to use liquid because it works faster, or even some powdered sugar under the tongue.
I have had extreme lows before… the lowest I have every been (conscious) is 30mg/dl. But I have also had a seizure which they said by bs was about 19mg/dl, very scary!
Personally a big thing in dealing with low bs, extreme or not, you have to stay calm…
Hope this helps!
hey, i dont know what you have been told but 78 isnt low, its normally 72 and under. Don’t worry about the high sugars, they are usually high after DKA, I reccomend a pump or omnipod after she has settled in with diabetes, as she is 11 she will probably qualify? and it really helps to stay in range! i’m 15 and always here to talk if you or she has any questions x
When you are first diagnosed, it takes a while to get all of your ratios at the right level. Keep working with your doctor and they will get it figured out. Also an occasional low is not too bad, if they become a pattern you will want to get an adjustment to the dose of insulin. For me, before bed time I absolutely make sure by BG is above 100. Night time lows can be kind of dangerous. I just make sure to check my BG right before bed and if it is on the lower end I will eat a small snack. A little bit of carb and some protein help a lot.
Thank you to all the replies. The learning curve is brand new for our family. I called her Endo Doc after hours last night as she had a BS of 61, true~staying calm seems to be harder for me, than her. We adjusted her Lantus (nighttime dosing) and will look into her Bolus ratio. She started back school and is very active with Dance/Lunch/PE being consecutive to her school day. Pretty sure Dennis you nailed it with the mid-day correction creeping up later at night. Makes sense.
I signed our family up for a Diabetes Summit here in Seattle, and also a Parent Info Night held at Seattle Children’s hospital. I am hoping the next few weeks get easier and her numbers/ranges get a little tighter. There are so many factors that seem to figure into her diabetes.
She won’t qualify for a pump until she is six months into her diabetes. Trust me, we would LOVE to get a hold of the newest technology out there. wink But, for now, we want to learn as much as we can and be confident in watching and regulating her BS.
Great responses, thank you.
one thing you may experience in the coming weeks is the weirdness of “Honeymoon”. Often times after you start insulin, your body will start to make some insulin too. This will lead to confusion about how much insulin she needs as sometimes she may not need any. This phenom can last 2 weeks to months and months. hang in there and I think you are doing great. you’ll learn all the language and start to develop your own instincts about blood sugar control. we are rooting for you.
Thanks Joe…yes, just reading up about the “Honeymoon” period. Appreciate the reply and advice. Could use all the rooting you got
My 9 year old daughter was diagnosed exactly one year ago from your diagnosis date. I remember feeling so overwhelmed at first, tired, scared, etc. but please know that is does get better. In the beginning, my daughter’s endo changed her basal (Lantis) dose and fast acting insulin carb ratio almost weekly until we had better numbers. If you could get on the the Continuous Glucose Monitor (CGM), night time lows are easier to catch because you will have an alarm to wake you up if she dips below a certain number. Our endo suggested we try to stay above 100 before bedtime. The honeymoon stage is challenging because your dosing can be correct; however, your child’s pancreas is still giving insulin at times.
Hang in there! If your logs continuously shows night time lows than the insulin may need adjustment if there is a trend. It is definitely not easy but it will be manageable especially if you have the technological tools to assist.
Lows are going to be very common. The glucose tabs are great for higher lows (above 60)!
The first lows are always so hard, especially coming off of all the highs. Lows can be scary and I know that it’s hard, but it always helps to be calm. I was diagnosed almost 2 years ago (I’m 17 now). Lows are tricky because you can’t always tell if they’re still going down, going up, or if they’ve leveled out. I love the mini airheads and mini packs of skittles when I’m low! They’re about 10/15 g of carbs and usually get my blood sugar up about 50 points (sugar effects everyone differently though so this is not universal). The fastest, and probably best, way to get your sugar up is juice. I always have two juice boxes in my bed side table so I can drink them quickly if I wake up low. My mantra when I’m low is “test and treat”. That’s about all you can do! Like your daughter, I am very active in/after school. I am on my school’s cheer and soccer team. Before practice, I like to have a small snack to boost my blood sugar so that i’m less likely to go low during practice or a game. Peanut butter crackers are great, but sometimes I just like to have some reeses or a snickers bar:) If my blood sugar is already on the high side before practice (180+), I just drink a little bit of gatorade throughout practice to help maintain it. That can be tricky though, if you drink too much it is easy to spike your sugar. Hope this helps:) I am always here to talk to you or your daughter. It makes it a lot easier to know someone can relate!!