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Daughter had a bad low this morning

Discussion in 'Parents of Children with Type 1' started by tammy82, Oct 8, 2014.

  1. tammy82

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    This morning when I checked my 10 year old daughter at 4:00 a.m. Her bs was 40. Luckily she woke up I gave a juice pouch, after that she started with the jerking movements and every now and then a blank stare so she was in and out of consciousness. I managed to get two juice pouches down her and cake gel a little while after and it took about 20 mins or so for her to come up to a good number. We did have the glucagon ready but was hesitant to use it right away as I know the effects are pleasant afterward. It was very scary and I'm still shaking over it. Thank god I was up at this time as my husband usually checks her before work at 5:30. This is the second time, the first time a few years ago when she was awake fell down and had a seizure which is when I used the glucagon.

    From experience of this happening to anyone's child was this the way to treat or should we have did a mini dose of the glucagon after the first juice box being she was alert at first. Not sure I went about this the right way.
     
  2. Nancy in VA

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    Sorry to hear that. Definitely sounds like a seizure. I think the biggest risk is that their swallowing could be compromised if they are having a seizure and you don't want to risk choking - so I think regardless of the after-effects, I'd go with the glucagon. I had to use it twice a couple years back and definitely my daughter felt like crap afterwards. But, when we didn't realize it was a seizure, we tried to get her to take juice but she couldn't, so we didn't have a choice.
     
  3. rgcainmd

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    You definitely want to use glucagon at the first sign of seizure activity, no two ways about it.
     
  4. tammy82

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    Thanks for,responding. Now looking back we should have done the shot i didn't realize it was so bad until after the first juice box which she was able to swallow at the time.
    I wouldn't chance it again if it were too happen again.
     
  5. Christopher

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    I am really sorry you had to experience that. If she was alert and able to swallow when you first were treating her low, I think you did the right thing, so don't second guess yourself. I would have done the same thing. However, I agree with the above posters that once she started showing signs of seizing, then you should absolutely use the glucagon shot. Hindsight is always 20/20, right? Hope she is feeling better now.
     
    Last edited: Oct 8, 2014
  6. tammy82

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    Thanks Christopher for replying that makes me feel a bit better. Yes knowing what I know now wouldn't do that again.
     
  7. jenm999

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    I was just going to post the same thing. Hindsight is 20/20 but you took action and she is ok! That is what matters. Bravo.
     
  8. mwstock

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    Tammy, i am sorry to hear about your morning! I would not beat yourself up or second guess your actions this morning. In the future I would say the glucagon would be the best course of action based on the severity of the low. It does sound like your daughter did have a seizure of some sort, based on the symptoms you are describing. Most parents do not realize the glucagon will treat and stop the seizures. We are taught to give it if unconscious for severe lows. You bring up a good point that a mini-glucagon dose can be given with a regular syringe during lows while ill or conscious. The seizures are often the result of prolonged lows...not necessarily the low itself. The best thing to do is to try to prevent the severe low by bedtime checking, bedtime snack and/or lowering basal insulin. There are a lot of factors, so i am not sure what lead up to the severe low blood sugar? Those random lows during the night scare the crap out of me. I am thankful when I catch them and am able to treat them before something like this. My son has had two low blood seizures and one with normal blood sugars. With his first seizure I used cake frosting and his blood sugar was above 100 when the firefighters and paremedics arrived. He got an ambulance ride to the ER. When you tell 911 a child has had and is having seizures they send out a small army. My sons second seizure was the last day of diabetes camp. His blood sugar was fine at midnight and I gave him a snack before going to bed. The camp doctor came in and gave a full glucagon dose because I had forgot to take off the safety...bent needle because I was running on pure adrenaline because I knew what was going down. My son was sick the remainder of the day and vomited multiple times. The low blood sugar seizures occurred while he was on injections and the seizures served as a catalyst for getting him on an insulin pump. Earlier this year he had a seizure while at a normal blood sugar 170. I checked him before going to work and my wife confirmed the same blood sugar after. He walked into our bedroom with a blank stare and did not talk, so we spent the remainder of the day in the ER with no finding and a referral to a local neurologist who does not accept pediatric patients. Thankfully no reocuurance. I will pray for you tonight that you have peace and can rest. You did everything by the book!
     
    Last edited: Oct 9, 2014
  9. sszyszkiewicz

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    I would just like to say that if my DS was able to drink juice I would have done the same thing. Also, you have to consider that 4am in the morning is not exactly the best time for making decisions.I am glad you were up and it all worked out!
     
  10. BarbDwyer

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    So glad all is well. How scary. I was under the impression the glucagon was for if they are unconscious or can not drink. This is good to know. I also did not know seizures occurred at 40. I skip night time checks sometimes - usually on the weekends when he stays up late and can test before he goes to bed. I get so freaking tired. Gawd. Never again. The other day he tested before walking home - he was 64 so ate some gummies but did not wait to walk home. I corrected him about that but not with the passion I probably should have to really drive home how important it is to take lows seriously.

    We have glucagon at home and at school and if we leave somewhere I take it but I need another one for my purse. If he was out and about, and I was called, I would not have it on me.
     
  11. Christopher

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    I would just suggest using caution when making assumptions. In this case the bg was 40 at testing but that number could have been higher or lower at that time. Additionally, the number could have been dropping fast so that by the time they began displaying seizure-like symptoms, they could have been much lower than 40.

    You are correct that Glucagon is mainly used on a person who is unconscious from a low. However, there are some people who use mini-doses of glucagon for a bg that is very low but the person is not unconscious. I have never done this so I can't speak to the specifics around this method of treating a low.
     
  12. shannong

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    If my son was able to drink, I would have given him something too. I like to keep Dex 4 liquid on hand for any really bad lows in the night. That stuff works amazingly fast. Sorry to hear that this happened.
     
  13. Nancy in VA

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    When Emma had her first seizure, she had just checked her blood sugar and it was 55. That's not unusually low for her to wake up, and she went downstairs to get something out of the dryer and then fell on the floor having a seizure. We were shocked because she was 55!!

    For the second one, coming so close after the first one, I didn't bother to check her. I knew what it was and that the number wouldn't make a difference. I gave her the glucagon and then checked about 5 minutes later and she was 95 - I have no idea how low she was then - she didn't wake up from that seizure and would have probably died had her brother not been sleeping in the room with her and woken up!
     
  14. BarbDwyer

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    I'm going to be gone for hours on Friday and I'm going to have my boys stay in the same room. Go over all the protocols again. Ugh.

    When I was in high school I worked with a man that lived alone and died from a diabetes low so I know it can happen. I would like to think all these years later it isn't as likely or there is better medicine or something but really - it is the same disease.

    Gawd. I'm freaking out a little bit. I'm so glad my son is old enough that I do not have to be scared to send him to school but on the other hand I can't just hire a babysitter for a teenager and I can't be with him 24/7.
     
  15. Christopher

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    I realize it may be harder for newly diagnosed parents, but I think it is important not to let panic and fear cloud our judgment. With the proper guidance, systems and training in place, a child of any age can safely attend school. With the proper guidance, systems and training in place, a parent can leave their CWD alone (depending on their age). Seizures and death from a low bg are very rare. That is no consolation to those parents who have had to deal with it and I feel deeply for them. But I think it is important for us as parents to put things in perspective and set a realistic example for our children and other parents of CWD. This is a very manageable disease and our children can have great lives as children and then as adults. It just takes extra work.
     
    Last edited: Oct 9, 2014
  16. GChick

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    if she was able to drink/eat the gel then you did just fine.

    Others in this place have more experience with glucagon than I have, so who knows... possibly glucagon may have been better/easier, but as someone whose parents didn't have access to glucagon when I was a child, sugar (usually through liquids) was really the only way to go without going to the hospital.

    You caught it. You got it up and that is what is important.

    In over 30 years with diabetes, I've still yet to use glucagon, and probably never will have the need/use for it (I currently live alone, so if I cant figure out how to drink a soda, then its unlikely that I'd have the mental ability to be able to figure out the glucagon process in that state, but luckily my lows are generally not "difficult" lows). There were about three-four times as a child that my parents probably wish they had the option.... but while stressful/difficult, sugar ~usually~ works (my parents learned some odd tricks to get stuff in me, you will too). So don't beat yourself up about it. You did good.
     
  17. rgcainmd

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    I just wanted to clarify that, in the event of hypoglycemia, if your child is still conscious and able to drink juice, glucagon is not indicated. However, if there is any seizure activity or loss of consciousness, it is advisable to use glucagon. Hypoglycemic seizures are bad news for developing brains. Please review this article:

    http://www.sciencedirect.com/science/article/pii/S0022347699702118

    Abstract
    Sixteen children with insulin-dependent diabetes mellitus were evaluated at diagnosis and after 1, 3, and 7 years. They showed significant declines in verbal but not visuospatial abilities, particularly if they had any seizures from hypoglycemia. At the 7-year assessment those with hypoglycemic seizures showed deficits on perceptual, motor, memory, and attention tasks. (J Pediatr 1999;134:503-6)

    Using mini glucagon to treat a stubborn low if a child cannot keep down any food or liquid is another subject entirely, and is not what I'm referring to above.
     
  18. missmakaliasmomma

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    I think you did the right thing too. I hope your daughter is feeling better.
     
  19. dpr

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    Last year at diabetes family camp Dr. Buckingham (probably the most famous research doctor on the West Coast) talked a lot about lows and had some interesting and scary information. The short version is the severity of the low along with duration are what cause seizures and death. With duration being a big factor. A blood sugar of 50-55 can cause seizures or death in about 6 hours in some people. Blood sugar lower than that would take less time. Scary information.

    As long as I thought my daughter could swallow I would give her juice too. This is a good threat to brush up situations like this. I'm glad everything is o/k now.

    So does anyone recall the Mini Gluc formula? 1 unit for every year of age? I don't recall exactly.
     
  20. rgcainmd

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    The following is from "Diabetes Disaster Averted #41: Glucagon Mini-Dosing -- A Valuable Tool":

    Note: the recommended dosing for mini glucagon is as follows:

    ages 2 years and under: 2 units
    age 2 to 15 years: 1 unit for each year of age (6 units for a 6 year old, etc.)
    age 15 years and older: 15 units
    I used a standard insulin syringe (not the harpoon included in the kit).



    Following is a link to the full article:

    http://www.diabetesincontrol.com/ar...erted-41-glucagon-mini-dosing-a-valuable-tool
     

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