Disagreement with husband regarding lows

Just now my son went lower than ever before: 33! Two and a half years into diabetes and this is the first time we have experienced such a low low! I gave my son a juice box to get him up quickly and around 10g peanut butter crackers for some extra carbs and to keep the blood sugar up. I also suspended his basal (actually I lowered it to 5%) for one hour. I was scared and wanted to get him up as quickly as possible without giving him too much juice which might cause a spike and a crash later in the night. My husband said I should not have given the peanut butter crackers because now I have complicated matters as the crackers will slow the absorption of the juice and we won't know how much he's going to come up and whether to give more carbs or not.

I am wondering about the expert opinions of those more experienced with serious lows. What is the best way to handle this kind of night time low?

 

the crackers are going to help him maintain... the protien is good. I would have done the same thing. Under 50, we are suppose to give 30 carbs. So a juice at 15, and the crackers at 10 is close.

 

Your son will need the extra protien and carbs to help keep his blood sugar up. Did you wait 10-15 minutes and retest first?

 

I think technically you're suppose to give the fast acting carb first and wait 15 minutes to check. Then once the BG is up you can give a protein&carb snack to keep the BG up (with insulin coverage). I just know that the CDE for Isaac stresses not giving anything along with the fast acting as it can slow the absorption of the fast acting carb and prolong the low.

 

For a low like that for myself, I would have given 15g fast acting carbs and rechecked in 15 minutes to check I was on the way up. If I was over 55 after 15 minutes, I'd have waited another 15 and checked again. If below 70 I'd have given more juice. If above 100 I'd have left it. If between 70 and 100 I would have given a snack of 5 to 10g carbs.

But I think I'm more used to lows at that level than your son. When I saw my first really low low (LO) I freaked out totally and ate about 50g carbs of glucose gel.

 

I agree with giving 15 g of fast acting, waiting 10-15 min. then rechecking. If over 70--then follow up with pb crackers. If not, give another 15 g, wait 10-15 min. and recheck again. ETc... until you see the number over 70.

DD's lows won't come up fast enough if we give food immediately following fast acting.

 

Huh...I always give the fast-acting and PB crackers together as well. I'm going to assume that waiting for 15 minutes for the PB may only be when it's a low low?? If she's in the high 50's or 60's I tend not to freak out anymore, we treat both sugar and PB together, retest in 15 and move on.

I never thought about it any other way, but I like the idea of waiting to give PB.

Corinne - This is HARD HARD disease on a marriage! Make sure you guys talk it out (tell him he was right after all if you have to!), forgive and more on. I've held on to so many things and it's awful! Good luck to you!

 

I think it depends in part on how quickly your kid absorbs carbohydrates. For me, it usually takes a good 30 minutes for my BG to come above 70 after a low below 50 (and that's with glucose tabs or liquid glucose - about as fast acting as you can get). I can't give insulin all upfront for meals, because my digestion is too slow - the insulin hits first. So for me, giving something slow acting at the same time as fast acting could be completely disasterous. There is no WAY I'd be higher in 15 minutes, unless I was already rising. If I was dropping (which I usually am when I catch a low), I'd probably be even lower.

However, I've read posts from people whose kids have their highest post meal spike 30 minutes - 45 minutes after eating. Their BG must have risen some after 15 minutes, even from slow acting carbs, and for those children I'm sure it would be fine to give fast acting and slow acting carbs at the same time to treat a mild low.

YDMV.

 

We don't give the PB crackers. You want to get the juice to absorb fast

And re: turning off the basal. Unless you have sustained lows you can't get to stay up, I wouldn't bother. It takes 1 1/2 - 2 hours to see the effect of that, so I would expect by that point, with 15g juice, PB crackers, and no basal, she's going to skyrocket. I would mess with the basal

 

We are in the fast carb first camp. I always tell my son to let the juice do its job. Something else can be eaten once in or near range if needed or desired.

 

Thank you everyone for the clarification!

But telling my husband he was right???!?!? Now THAT is hard!

 

Fast acting carbs and then check after 15 minutes.

Something also to keep in mind. When my daughter reached 29 and was not "crashing" as my dad puts it, we contacted the Endo. We were told that anything below 50 is not precise with the meter. They know that you will give carbs for anything under 50, so it will not be exact. so even though mine said 29, she could have been anyplace under 50.

 

We were taught the rule of 15. Give 15 fast acting carbs, wait 15 minutes and retest, then give 15 slower absorbing carbs with protein.

 

We rarely follow up with slow-acting carbs. The only reason to do that is if there is IOB or if you think the basal is off. For my son, 30 uncovered carbs, plus turning off basal for an hour would result in a massive, massive high about 2 hours later.

 

We also always treat with glucose tabs, recheck 15 mins later, and if there is IOB or he had been running around hard, I'll follow up with protein. Usually though, that's not needed.

 

You know, I never waiting 15mins, retest, etc, until I read it here. Our intx were to : below 82, give 100ml milk, below 62, give fast acting carbs (tabs or juice) AND milk or crackers. So, for a couple of years, this is what we did, and it always worked. Granted, we tended to overtreat, but it did work.
Now I do the 15mins thing.
I also will turn off the pump for 1/2 hr to 1hr max. if there is a lot of IOB. If not or none, then I leave it on.

So, IMHO, you're both right.

 

Sorry, I agree with your hubby. Also, I would have given MORE than one juice for a 33. Juice does not cause spikes and drops. It may send them up too high if you over do it..., but it will not drop them later. If you have experienced a spike then drop from a low that was probably a rebound. Especially if the spike was over 300.

It's not that the crackers are a bad idea...Just wait until he's back in range first. Another reason to do it this way is because the crackers wont bring him up fast enough so you give more juice THEN the crackers kick in and make him go high. Does that make sense? I only add crackers if I know Seth has had a lot of exercise and I need to keep him up. I usually use ice cream or a go gurt

 

Again, thanks for all the input.

Just to follow up, after I gave the juice and pb crackers, and turned the basal to 5% for one hour he came up slowly and steadily and did fine for the rest of the night.

But next time I will give juice, retest in 15 mine and then give the pb crackers.

 

I've appreciated reading through every one's approach as I've had very few lows like this and they've freaked me out. We got through them without having a well articulated plan but it definitely helps to have seen what you all have to say.

I would like to comment on what I read as some criticism of Corinne's response from her spouse. Rob and I realized early on that in any given situation there are many factors to consider and weigh in the situation at hand based on all of those---at any given time, he and I might arrive at differing approaches to solving the problem. We made an explicit agreement to not second guess the person who is managing the situation.

Corinne, all is well that ends well. Ya did good!

 

Regarding KHM's post: this seems like an important conversation to have with a spouse - and I think I will initiate one. It is SO easy to second guess, blame, and forget to be grateful that you have someone else to help with such a difficult job. This could be the subject of a whole different thread - how to work WITH a spouse in caring for a d child as opposed to getting into struggles with a spouse.

Thanks.