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Gary Scheiner: Forget the "rule of 15"

Discussion in 'Parents of Children with Type 1' started by Michelle'sMom, Jun 21, 2013.

  1. Michelle'sMom

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  2. nebby3

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    It's good to see it in writing but it seems like one of those "well, duh" things to me.
     
  3. Michelle'sMom

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    For someone with experience, yes. For families new to T1 that are still holding on tight to all the rules, it might be helpful.
     
  4. Debdebdebby13

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    It does seem kind of "duh" but then again, our endo never told us we had to stick with 15 carbs to treat a low. When she was honeymooning it took only 1 glucose tablet, so 4 carbs to bring her up usually. Now it takes 2 glucose tabs, or 1 Quickstick, so 8-10 carbs to bring up an "average" low. Of course it takes more sometimes, depending on the situation.
     
  5. funnygrl

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    I like this. Being bigger I've long ago discovered 15 isn't enough for most lows for me. I've always felt kinda like I'm "over doing" it with lows, but I know what works. It's nice having they validated and having an actual guideline.
     
  6. mmgirls

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    I find the chart he has about what 1 gram of carbs will raise your BG interesting, while we do fit into the range I find the ranges after the first surprising. How do others feel about it?




    Weight in Pounds (kg).........One gram of carbohydrate raises blood glucose by:


    <60 (>28)...........................................6-10 mg/dl (.33-.55 mmol/l)

    60-100 (29-47)....................................5 (.28)

    101-160 (48-76)..................................4 (.22)

    161-220 (77-105)................................3 (.17)

    >220 (>105)........................................1-2 (.05-.11)
     
  7. MomofSweetOne

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    My daughter fits onto the chart.
     
  8. shannong

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    I asked our dietitian once early on about whether we needed to use 15 grams for a low because I was finding that it was too much. Because the Canadian Diabetes guidelines state that 15g. is the amount that should be used, she said that she would not ever say not to use that amount. It would seem that the medical profession is bounded by their own rules. It was yet another moment that I had to learn to NOT listen to the medical professionals.
     
  9. cdninct

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    K is under 60 lbs, and 1 gram brings him up 10 mg/dL, so he falls within range. 15 grams brings him up slightly over 150 mg/dL, which is always too much!

    It took me some time to figure out that I could "break" that rule. For quite a while, I cheated--gave the 15g but then corrected for much of it at the 15 minute mark (not exactly what is meant by the 15-15 rule!). Then I realized that that made even less sense than just giving 1-2 glucose tabs!

    Even now, I know people whose kids have been dx-ed far longer than mine who use the rule and then get upset because they overshoot every time. :rolleyes:
     
  10. Michelle'sMom

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    The ones I know curse that dreaded "rebound" high, like it's totally out of their control. :confused:


    My dd doesn't fit the chart. Not surprising, since she's never followed the rules. 1g will raise her 8-10 pts. I'm told the IR is to blame.
     
  11. deafmack

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    I have never followed the rule of 15 for raising a low blood sugar. If I did that I would be in the stratosphere. I know that the rule of 15 might work for adults that need 15 grams of carbs to bring their glucose up to normal range but I have found that it is too much for me.
     
  12. TheFormerLantusFiend

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    15 is slightly too much for me for a mild low - one that just drifted down slowly and hit my low threshhold.

    But I often use much more than 15 grams because a lot of my lows are not slow drifts downwards, they are quick drops and I need to treat the drop and the low at the same time.

    I'm a little over 100 pounds right now and one gram raises me between 5 and 6 mg/dl if I wasn't dropping (closer to 6 than 5). For some reason at about the same size years ago, one gram raised me only about four and a half mg/dl and it took me a long time to realize it had changed.

    My biggest problem with the rule of 15 was always the "retest in 15 minutes and retreat with 15" because my lows are very rarely up in 15 minutes and while 15 grams is a little much, 30 grams can really be overkill. A lot of my early lows in the two months after diagnosis were followed by blood sugars in the 250-350 range about an hour later.
     
  13. cdninct

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    Agreed. In 15 minutes, the glucose might slow or stop a drop, but we never really see upward movement until about 25-30 minutes.
     
  14. Mimi

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    I had a similar situation with our dietician. We actually had a bit of an argument.

    She couldn't understand why I would treat with less than 15 carbs and then if needed treat again with a few more carbs. "Why not just give 15 carbs? If she ends up at 290 it's not really that big a deal."

    UGH! :rolleyes:
     
  15. KatieSue

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    Once we started disregarding the rule of 15 it was so much better. Sometimes she needs less, sometimes more, we're better at figuring it out now. And we wait at least a half hour to re-test. When we followed the 15 carbs- test in 15 minutes we were always shooting her sky high because we would always end up giving her more at the 15 minute mark because she wasn't back up yet. Then at 30 minutes or 60 she'd be sky high.

    Now with the CGM I can see how long it takes the carbs to hit. It's at least 30 or longer especially at night.

    I think it's a fine starting point/guideline but I don't think it's a good hard/fast rule.
     
  16. wilf

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    Saying that every child with Type 1 D should receive the same amount of carbs to treat a low is as brainless as saying they should receive the same amount of insulin to correct a high.. :rolleyes:
     
  17. MomofSweetOne

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    I was very relieved at diagnosis to be given a set, easy amount to use compared to the old days of just feeding. I think I would want that again, but I'm also glad we learned within two months that 15 was not a required set numbers.

    We learned so much at diagnosis, but our hospital hasn't done any training since. It's all been learning on my own. I think it's a shame they don't offer continuing classes for the first year, to send one home with the basics to keep the child alive but then teach how to adjust doses, etc. in classes that meet once a month or so until the finer points have been covered....or at minimum, direct parents to the Type 1 University classes and books like Think Like A Pancreas rather than the Pink Panther that teaches nothing about management beyond the very basics.
     
  18. shannong

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    Usually it takes a good 30 minutes or more for my son to come up from a low. However, when my son is having a bad low, I have started using Dex 4 liquid. That stuff is amazing in how quick it brings up a low. If my son is not up in 15 minutes with the Dex 4 liquid than he does need more carbs. I don't like how much it costs though - 2.99 for a small 15g. bottle.
     

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