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Our lowest yet- 38

Discussion in 'Parents of Children with Type 1' started by forHisglory, Nov 15, 2015.

  1. forHisglory

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    Went to the playground for about 2 hours today. Used Dex and DS had a couple 60's from all the activity (confirmed with fingerpricks). Overall gave 44 g of juice and 12 grams of fiberone granola bar uncovered while we were there. Got home and he was 264 steady (confirmed finger).Corrected with our normal correction factor and he goes to watch cartoons with his brother. 1 hour later he comes to me and tells me, Dex says 61 double arrow down. Fingerprick is 38. Holy moly, I give him a juice box and he asks if he can eat. Scarfs down a bag of snack size chips (hey, it what he wanted).

    His only signs were feeling shaky and hungry. I have no idea how this happened....finger was clean, maybe the 264 was just an adrenaline type exercise high?

    So scary and I had glucagon ready to go.....I was so shocked he didn't have a seizure or something. This disease is truly crazy complicated unpredictable sometimes. Did I miss something obvious??
     
  2. sszyszkiewicz

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    there is a rate of change alarm on the Dex. Double arrows down dont happen often but when they do they mean business. Getting just one of those alerts in the hour before the low would have make a big difference in your awareness level (your spidey senses would be activated!) On your receiver Alerts-->Advanced->Fall Rate

    You also learned something about how activity affects your particular son's correction factor.

    With extra exercise (and what 6 year old boy isnt active!) hit that temp basal on your pump and Be on the lookout for lows after bed.
     
    Last edited: Nov 15, 2015
  3. msschiel

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    Wow, that is quite low! I remember my son's first summer during his honeymoon. He would go down to 40 or near there. If we were outside playing and had to eat supper, he wouldn't even have to give a shot most nights (Which was nice). Thankfully he felt these lows because we do not have a dex. Did your son feel the lows?
     
  4. forHisglory

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    :welcoming:
    I forgot to mention that he was completely disconnected the entire time he was at the park. And, yes, we have that alert set for double arrows. Mama was busy making dinner for the family and somehow didn't hear the alert. My son picked it up on the Vibe, but I never heard the receiver. Just scary and wasn't expecting that at all. You are right that I'll be much more carful next time. :( Spidey senses will be there to catch the fall with a snack.
     
    Last edited: Nov 15, 2015
  5. forHisglory

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    He didn't feel it much until he got there. But thankfully he is very hypoaware most of the time. This episode really shook me up. Diabetes hasn't really been that scary for me until that. I want to learn from it, but I also just needed to express my fears! Now, to move on. He ended up running high all night (high 200's, one 300) but I was very cautious in correcting.
     
  6. sszyszkiewicz

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    Fyi my kid dips into the 40's once per week, and I bet most kids do, the difference is with the cgm they dont stay there long. Its like when the weather service installed better radars a few decades ago, the number of reported tornadoes went up, not because there were more tornadoes, but they were just detected more often.
     
  7. forHisglory

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    Once a week, really?! Ahhh. Have you noticed the Dex can't keep up with fast drops(here it did). But at the park he started out at 140 and was down to 60 in the first 30 min. He caught it though, not the Dex. I'm guessing the mechanism for a high afterwards is just mainly hormone......but with all those uncovered carbs I was thinking "carby" high. I'm thinking with recent activity I may to only give a third of the correction now.....glad we can detect tornadoes by the way. Good analogy. :)
     
  8. njswede

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    We are seeing excitement highs when Noah plays football. We generally don't treat it during his activities (unless it's in the 300s) and we correct it with half the calculated dose afterwards. That works for us.
     
  9. forHisglory

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    Very helpful. These activity highs are pretty "empty".....kind of how I'm thinking of it now. All highs are def not created equal! :)
     
  10. Theo's dad Joe

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    This is scary. My son was 220 about 4 hours after lunch one day and I gave him 1 unit correction. His correction factor seems to be about 70 which would have put him under 100, but I figured it would take near 3 hours so I would see it coming down slowly if he was going lower. About 45 minutes later he was 160 so I bolused for dinner and gave him his normal dinner and in another 45 minutes he was 92 with a down arrow. I did a fingerstick and he was 44. I gave him some fast carbs and dex read 72 and down. Dex stopped around 60 10 minutes later but by then his fingerstick was already back to 72 and that was with (only) 9 grams of glucose. I think the brain probably still has glucose for a few minutes during a fast drop that is corrected right away.

    I also had him come up to 190 by dex and fingerstick 4 hours after dinner and did a half unit correction before bed and watched but 30 minutes later dex was 130 and down and fingerstick was 85, and I would think that most of the correction was still on the way. It could have been that Lantus kicking is has a little ability to correct the blood sugar especially with the honeymoon still giving him some insulin. I gave him about 10 grams snack (more than what the half unit correction would have covered) and he ran great the rest of the night. I watched close for about 4 hours.

    I do have a question though. When your son went low at the playground, were you within a mealtime window? I ask this because pretty much my son is within one of his meal time bolus periods all day long. He eats breakfast around 7:00-8:00, Lunch from 11:00-12:00 and dinner between about 4:00 and 5:00 so he is never really "out" of a mealtime bolus window between about 7:00 and maybe 9:00 pm so when you see a 264 are you still in the window of a meal bolus at that point. Also I have been told that fast carbs will make your blood sugar look higher fast but that that is partly because blood sugar is sent to the extremities (head, limbs and skin) first and then the blood sugar equilibrates down some on its own. 44 grams of juice is out of my context at this point. I have given Theo 12 grams and gotten a 120 point rise.

    I also can't yet comprehend these activity lows. Theo can run around for an hour and not have his blood sugar phased by it at all. I DO think that corrections during the honeymoon are the most risky because the higher blood sugar is forcing the remaining beta cells into self defense mode.
     
    Last edited: Nov 15, 2015
  11. DiabetesMama

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    Wow! Scary, I know! We have had similar things happen after a hard play with our son too. I do think that the high was just a quick high from absorbing all those fast acting carbs and then it drops really quick again. We had that happen to us about two months ago. I know now after several months of using the Dex that those arrows do mean business. When we were playing catch for about 30 minutes or so, he was dropping like a brick within half an hour. What I am unsure of is there a way to treat enough to bring him up but not into the 200's and then drop back down again? Is there some magic way to bring up the number fast but then slowly keep him stable instead of rising so quickly then bottoming out? Because the juice and cracker method they swear by at the endo's office does the same thing. It brings him up into the 200's but after an hour or so he's falling again. How frustrating! And the bit they tell you after first diagnoses that they can do everything that they did before is not accurate. Well, he still can play and have a good time, but you end up spending the rest of the day and well into the night trying to get them leveled out again. Good luck sleeping when you're scared to death you kid won't wake up because of all "the good exercise" they want you to have. Sorry, just venting. I am sorry you are going through this too. The up's and down's with the numbers is probably the most frustrating to me because you can do the exact same thing for two or three weeks and then the next day, it's like you have to reinvent the wheel. Hope things get stable for you soon. We have been fighting lows this past week and he has started to loose his awareness of them and we tested and he was like 36 one time! Be glad your little one can still feel them. Sometimes the Dex is running a few minutes behind the low, so if he says he feels low or just weird, stop and test. We have caught a few lows before the Dex did. Trust your gut.
     
  12. rgcainmd

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    We've learned (and are still learning) which types of exercise tend to make my daughter go low (and to what degree to a certain extent). Marching band/color guard is one of them. So this is what we do: anticipate. 1.5 hours before these activities, we set a decreased temp basal anywhere from 15% to 25% to last for the duration of the activity plus 1.5 to 3 hours after the activity. This way we need to do little, if any, correcting for any lows during the activity. This method avoids the "over-treating" rollercoaster that can lead to a high towards the end of or after the activity. Extending the decreased temp basal for a period of time after the activity helps avoid those post-activity lows.

    It's a matter of trial and error, and not counting on any strategy as if it were a "formula", because as most of us already know, T1D does not follow the rules and does not play fair!

    ETA: We've found that the G5's 505 algorithm leads to readings that "recover" from lows and highs (to a bit of a lesser extent) more quickly than the G4, which significantly helps with the strategy outlined above. And I'm learning to heed the arrows more mindfully and pay attention to the "bends" in the dots per Stephen Ponder's Sugar Surfing, which I highly recommend as a more "advanced" text once you've been battling the D beast for awhile.

    EATA (Edited again to add) the almost ubiquitous YDMV, especially during the honeymoon, when I felt like we were flying by the seat of our pants a great deal of the time. Which is why we've been much happier campers since the honeymoon ended; unlike some marriages, T1D has been a lot "nicer" after the honeymoon...
     
    Last edited: Nov 15, 2015
  13. rgcainmd

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    Agree wholeheartedly with this analogy! (Although our lows have been less frequent and severe for the past 6 months or so because of The Dark Force, puberty [cue doom and gloom music].)

    I've learned to be significantly less knee-jerky and heavy-handed when treating lows and more patient after treating lows. "15 wait 15" went by the wayside quite some time ago. We sit, cool our jets, and wait at least 20 to 25 minutes for a low to more gradually make its way back into the more comfortable 70s or 80s or 90s.
     
    Last edited: Nov 15, 2015
  14. nebby3

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    These lows are scary but sadly you will come to get used to them too. After 12 yrs with D we've certainly had our share. A sudden rise with physical activity for my dd usually means adrenaline and those highs tend to come down a lot on their own. Also playing in colder weather produces worse lows as the body has to work hard to keep itself warm. Playing in the snow and swimming are very good at making lows for this reason. And as you learned the lows can often come an hour or two (or8) after the activity. While cgms help there is a lag time plus life happens and you are not going to catch every one as early as you'd like. The point is he's fine now. You both survived it and you've learned some things to apply next time.
     
  15. njswede

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    Well, YDMV, but it may be worth a try.
     
  16. forHisglory

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    These responses were incredibly helpful to me and I want to reply. It seems as if our newest family member has decided to arrive...yay mixed with "yikes" as my T1 will be in grandparents care for the first time ever overnight. I will reply individually soon! Rgcainmd, that strategy is phenomenal...and actually this post was very educational for me.
     
  17. DiabetesMama

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    Yeah! Congratulations on the new baby! Boy or girl? You doing ok? Hope things go smoothly for you and your family. Take care of yourself!
     
  18. Snowflake

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    We find that CGM, while very useful, doesn't always catch rapid falls or low lows in our daughter. It seems like it just has more of a delay for us than for other users; totally unscientifically, it seems like that's reported more by parents of younger kids.

    Good luck with your new arrival! We've now managed T1 along with two newborns, and man, can that be hard. With our newest baby, my dh handled T1 overnights most nights (like 6 out of 7) for the first two months to give mama a break while I was up nursing the baby. But, at some point, it kind of turned into a natural rhythm for me to eye the Dex whenever baby stirred. Fortunately, after three kids, we finally got a good sleeper this time around, so we're getting back to T1 being the main sleep culprit in our house. I hope the same for you!
     
  19. shannong

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    Exercise tends to make insulin very powerful. If my son has been active for a significant period of time, I am very cautious when correcting highs. He needs probably half or less of his normal correction.
     
  20. Theo's dad Joe

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    I read something interesting this week that matches what most Rgcainmd and others seem to have arrived at by experience. When individuals exert themselves at a high enough intensity to get a large adrenaline surge (very high intensity only) the adrenaline surge will block insulin from working very well and so the rise in blood sugar, BUT it also signals the liver to stop disposing of IOB and also IOB does not get used up "trying" to move glucose into cells, it just gets blockaded altogether and will still be "on board" after the adrenaline surge has passed. This is very interesting to me because I would have thought that insulin on board would be basically "one hour" gone after an adrenaline high of one hour, but apparently it mostly sits around and waits. This seems to match the observation of "empty" highs, or of giving insulin for the high, but making up for it with food or cut basal.

    http://diabetes.diabetesjournals.org/content/51/suppl_1/S271.full
     
    Last edited: Nov 16, 2015

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