My daughter is newly diagnosed 3 weeks ago. She was in DKA, ICU and hospital. We left the hospital quickly because of all covid stuff and in close contact with her endo doctors and dietician. Last weekend we had so many overnight lows like ever 2 hours so I would give her OJ and and peppermint candy to bring her blood sugar up the next day she complained of sore throat and had a stuffy nose so she seemed to be sick with a cold… She got over the sickness and went back to school this week. Again last night started with the lows every 3 hours. She has the cgm the doctor installed and few days after getting out of the hospital The OJ is working along with mints when she is below 70. Is there any other items that may help her and last longer during these times. She is physically and emotionally exhausted and now I am too. Thank you in advance
Juices and candies raise blood sugar quickly but don’t have much “staying power.” Peanut butter- or cheese crackers can help keep things steady. You’ll be working with her doctor to tweak her doses of basal and mealtime insulin to tprevent the lows in the first place. It will take a bit of trial and error to find what works well. Try not to get too frustrated - it’s part of the process and is something we all have to do from time to time. Work closely with doctor now - in time, with training and practice, you’ll learn to do it on your own.
There is a book called *Think Like a Pancreas * by Gary Scheiner. He has Type 1 himself and works in the diabetes field so he has a unique and very helpful perspective. The book is a fun read and hopefully will help you with what you learn from your endo.
All the best to you and your daughter.
I understand the exhaustion all the way around. What I’ve found to help with overnight lows is to give some apple juice to raise blood sugar quickly followed with slower acting carb …something like mini muffins, goldfish crackers, peanut butter crackers etc. to keep the blood sugar steady. Call in to your diabetes nurse educator as much as needed to help adjust correction factors if she continues to have lows. If your child is having lows during the day also you show ask your educator about decreasing basal (background insulin) dosing that may lead to you needing to adjust (increase) mealtime insulin correction factor also. Since she is newly diagnosed there will be a lot of adjusting until you find what works best for her. I’ll keep you both in my thoughts.
Thank you so much. I am going to keep doing what the doctors are telling us to do and add a little bit at a time of the helpful tips given.
@bltfamily1 Hi Brooke, and Welcome to the JDRF TypeOneNation Forum!
Initially you did what was right to help raise your daughter’s BG to what you may feel is a safe level, but as both Dorie and Stephanie wrote, you didn’t follow through sufficiently to keep your daughter’s BG a little higher. The OJ and candy does work very quickly [I have done that for decades] but those “quick carbs” often cause her body to react in a vay that might cause her to either go “low” again quickly or drop even lower than she had been - especially if her body might be still producing some insulin.
My practice developed over seven decades using injected/infused insulin to keep me alive is to make an educated guess as to how many carbs I need to bring my BGL up to an acceptable level and split that snack between fast & slow acting carbs. Such as a few ounces of juice combined with crackers and peanut-butter. Remember that breads/crackers act slower than OJ and the fat content of PB lengthens the duration of the carb action. Stuff your daughter and you will notice over time - after 65 years with diabetes, I’m still learning. When out and about, I find Protein / Granola bars convenient - 7 grams of fast acting “sugar carbs” combined with 9 grams of slow release nuts and chocolate. And tasty too.
I’m not practicing medicine here so I won’t add my medical advice, but please speak to her doctor about insulin dose and timing.
An after thought Brook @bltfamily1 concerning her continuous monitoring device - probably the most useful device for effectively managing diabetes; my opinion, anyway.
The numbers are good and very useful information, but more importantly are “arrows” and your ability to see your daughter’s glucose trend. For instance, I will always glance at the recent three hours to see where I have been - and from experience when I recall what I’ve been doing for the last few hours [eating, exercising, insulin dose, etc.] I can sometimes guess where I’ll be within the next hour or so. I always do this before going to bed at night, and before beginning an activity - especially driving.
Hello Brook and welcome to the forum. I have found that Glucerna and Boost protein drinks can prevent BGL spikes and can help keep them at a tolerable level without wearing off too quickly before going to bed. Treating BGL lows is time important, so intervention is key. It is a good idea to talk to her endo and doctor for a perscription for Glucagon or other hypoglycemic emergency medications to treat her quickly if she ever becomes unresponsive, and don’t hesitate to call 911 if you feel you need to. Just say my daughters a type 1 diabetic and she’s unconscious, send someone now. They’ll come to her aid and help. I personally have found chocolate milk to stablize a falling BGL quickly and lasts longer than high sugar soft or juice drinks if caught early enough.
Yes they gave me the glucagon nasal powder for emergency and I have given one to her school as well. She is having her snacks in between meals pretty much every 3 hours after eating a meal under 15 g of carb and then her bedtime snack which sounds like when I would give her the boost drink. I appreciate all the infomation.
I sure appreciate the information there has been so much in the last couple weeks to remember. I have taken stock in Kind bars for snacks. We will see her endo next week and I am sure at that time they will look at all the trends on her Dexcom. I have familarized myself with the 2 straight up arrows and the 2 straight down also the arrow straight across to the side which seems to be the best. In your opinion if it is in between the side and down would you then snack on something like nuts long acting or a short acting card to bring it back up and straight across? I know it’s pretty direct and I just thought to ask, no biggy of your not comfortable. Thanks for all the good information
Brook, much depends on where the number was before, and what it is currently - and keep in mind that bodies are all unique and “fixes” are something that will be learned. With Dexcom:
- The horizontal arrow means that BGL [Body Glucose Level} is changing at less than 1 mg/dl per minute.
- An arrow at 45 degrees means increasing or decreasing between 1 and 2 mg/dl/min meaning that within 15 minutes she could be as 15 mg higher or 15 mg lower.
- A single arrow up means upward change of 2 to 3 mg/dl; single straight down means dropping 2 to 3 per minute.
- Double arrows mean the per minute change is three mg/dl or greater. Assuming, the number reads 100, 15 minutes later she could be as low as 55 mg/dl - impending danger which should be treated with rapid-acting glucose such as gel or fruit juice. The fastest acting juice for me is grape or apple/grape.
My practice, and I’ve learned to share openly, I never go to bed without a snack if my arrow is pointing anywhere other than horizontal or up, and in my time before using an insulin infusion pump [no more background or long-term insulin injections] I made sur my BG [Blood Glucose] was at least 125 mg/dl - my safety level. Now I have both my pump and Dexcom nighttime In-Range settings at 85 and 145 mg/dl; meaning I will receive a “low alert” when my G6 anticipates that my BGL will drop lower than I want. When I’m awake, daytime, If my reading drops into the 70s and arrow pointing down, I will use some fast-carb such as OJ or a glucose tablet pols crackers & PB; if in the 70 and horizontal arrow if my meal is about ready, I’ll wait or just have a couple of crackers or pretzels. Much is based on my experience, and I sometimes guess wrong.
While you are learning, don’t be upset too much by over treating a “low”, or needing to add some fast-acting food later. One thing I think everyone does is “over treat” a low and cause BGL to go high - IMO, this can be much safer than not catching a severe Hypo.
Thank you for taking the time to explain with all the information. I know I read and watched the video however the way you explained has really help me to understand.
There is a sad but true expression amongst diabetics that it’s a circular pattern take insulin, low blood sugar, over treat , high blood sugar, take insulin and repeat. This is sometimes what it feels like. As time goes on you will get better at adjusting insulin vs intake of carbs. Don’t forget activity levels also affect glucose and insulin absorbtion both. Hang in there it does get easier with practice even if no less frustrating.
Thank you for caring and sharing your knowledge it has really helped us this week.
Always a pleasure. Keep us posted on how things are going!
Everyone here has excellent knowledge and advice so I won’t really add much except to say that I feel for you! When I first got my CGM (about a year after I was diagnosed) I was up every 2 hours for a couple weeks. My mom said it was like having a newborn in the house again! Over time, we (my doc, nurse, parents, and I) realized that I had way too much insulin going on and by using a pump and cgm together, I was able to cut my insulin almost in half. I never would have known it without a cgm though!
I sleep with caprisun by my bed so I can just roll over and drink juice anytime my cgm alarms. Also, I found milk is one of my best stabilizers. (I know a lot of people don’t just drink milk but I find it helpful . . . and delicious!) Anytime I can’t keep my bg up and level at night or if I have been super active and know I’m going to crash overnight, I drink a glass of milk. Something about the combo of carbs, protein, and fat pulls me up and keeps me up. Chocolate milk works too but WAY more sugar so just be aware of that.
Anyway, that’s my 2 cents. Just know that this is a season and yes it’s hard but with practice and commitment, you’ll get there! I got to the point that nights were my favorite things to look at on my cgm because every single night was 8-12 beautiful hours of straight line perfect sugars. (Not always the case right now, but I’m working on it!) It’s doable! Hang in there!
We rely on a glass of milk after exercising — just like you said, the ratio of protein to carbs in milk makes it a great recovery drink for anyone, T1D or not — but it never occurred to me to add it as a before-bed stabilizer. That’s a great idea, thanks!
I’m just seeing this now on Sept. 24 and wish I had seen it earlier, but to me, it sounds like she has started the “honeymoon phase.” You need to ask your diabetes team about this. The honeymoon phase is a limited period of time starting after diagnosis. In some people, injecting insulin “jump-starts” the pancreas, and it begins producing some insulin of its own. This leads to low blood sugars. Injected insulin needs to be reduced to prevent them from happening. Again, contact endo for advice, but I think this is what is happening.
Everyone is different I guarantee you and I would encourage you to only use what doctor says as a base. Your daughter is getting too much insulin before bedtime and until you figure out how her body reacts I would go back 5 hours from the lows and adjust. I am assuming she is not on a pump.
You are correct she is not on the pump just Decome CGM because we are very new and diagnosed just a month ago. Talked to the doctor on Monday and they lowered long acting insulin and I definetly not going to do anything without the doctors okay. What they did worked because she has had no overnight lows since.Thank you for the information it all helps.
Lauri, U fully agree with you that the so-called “honeymoon phase” is of limited duration, and during phases [yes they do re-occur] the proper management is to reduce injected or infused insulin. But, these honeymoons do reappear well into old-age.
The Joslin Medalist studies, an extensive review of the diabetes history of persons living with diabetes for more than 50 years combined with deep physical current conditions reveals that many persons surviving for over 50, 60, 70 years with diabetes will from time-to-time produce some of their own insulin. I for one, 65 years into this diabetes game, went through a period this summer when my daily insulin needs cut in half.
The bottom line I receive from this, is we ned to be aware and be properly knowledgable to adjust our own insulin dosing. As one of the presentation slides I’ve used reads, "CHANGE is the one CONSTANT in diabetes management".