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T1 2.5 yo angry, shaking, blue-tinged skin, nurse says it's not insulin-related?

Discussion in 'Parents of Children with Type 1' started by vdamico, Mar 8, 2016.

  1. vdamico

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    I'm new here and very new at parenting a child with diabetes, so apologies if this has been addressed in another thread, or if I'm going into unnecessary detail.

    A little background: My 2.5 year old daughter was diagnosed with type 1 diabetes at Sicks Kids hospital here in Toronto, Canada about two weeks ago. We caught it before DKA so she's been an outpatient. We meet with her team once a week, keep food logs to show them, and phone in with her blood glucose readings each morning to get her dosing for the day. She weighs about 33 pounds and is currently on 7 units of Levemir in the morning, and roughly 2.5 units of NovoRapid before meals. She started with .5 in the hospital and they've been slowing bringing up her doses.

    On two occasions, she has had uncontrollable shaking at breakfast after her two shots. It wasn't violent, but it was as if she had fallen in cold water and was shivering hard. It started with disoriented anger (insults; asking for items of food, then knocking them away; telling us to go away, then to cuddle her) screaming and tears. Then she would begin to calm down and eat, and shake. She was alert, speaking to us, and trying to eat her breakfast but needed some help, due to the shaking. The skin around her mouth and under her fingernails took on a bluish tone. She said she was cold, she asked my husband and I to hold her hands. Her heartbeat was quite fast. It passed after about 10 minutes each time.

    We asked our diabetes nurse and she said we should contact our regular pediatrician, as this didn't seem related to her insulin shots. That doesn't seem right to me--it's happening right after her shots as she begins to eat. Can anyone advise me what might be happening here? Is this just a low from her shots, before her breakfast has gotten into her system? (We're working hard on developing some language and awareness as a family about feeling high/low, but we're not there yet.)

    Incident #1 - AM blood glucose was 16.6, 2.5 units Levemir and 1 unit NovoRapid.
    Incident #2 - AM blood glucose was 12.2, 7 units Levemir and 2.5 units NovoRapid.

    Thanks in advance for any insight you can provide!
     
  2. nebby3

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    I'd start by checking her blood sugar during one of those occasions if possible. Even if you have to hold her down to do it. I've never heard of quite such a reaction but I don't see how they can rule out a low bg without more info. You could also try getting food into her earlier to head it off or delaying the insulin even 15 minutes to see if that makes any difference.
     
  3. Lakeman

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    It sounds like she was a bit high (rather than low) during each of these episodes. That is assuming that when you said her BG was 16.6 that you meant 16.6 mmol/l which would convert to about 298 mg/dl. Blue skin can be caused by circulatory issues and I would not expect it to be a side effect from insulin - especially so soon after giving the insulin. (insulin peaks about an hour and a half after it is given)

    I would also wonder about anxiety or panic attacks. At her age I would not expect her to be able to talk about feelings of anxiety and she just might show it by shaking and mood shifts. It is not uncommon for people to be pale when they are anxious. Could pale skin allow you to see an underlying blueness? Or since pale skin is caused by blood flowing away from the extremities and so is blue skin is this just more of the same?

    Regardless I would see your GP as soon as you can just to rule out some things.
     
  4. wilf

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    Could you clarify the amount of insulin she is getting - is it 2.5 units before each meal, or 2.5 units being boluses each day?
     
  5. wilf

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    Could you also measure blood sugar next time she has one of these episodes? That will help sort out what is happening.
     
  6. vdamico

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    Hi everyone, thank you so much for your replies and you're so right, we need to check her the next time it happens. We met with her nurse today and she spoke with an endocrinologist on duty who suggested the same thing. In hindsight, it's obvious we should have done that. I look forward to the time when checking her becomes second nature.

    Roberta, we have permission to give her a bit of milk after her morning check/phone-in and before call-back/shots. Maybe this will help, even if she's not low but just really hungry and getting incredibly upset about having her breakfast delayed.

    Lakeman, this is what the nurse and endocrinologist suggested, that it might be what a panic attack looks like in a toddler, and that the shaking might be her body working out the stress hormones from the initial "tantrum" phase. In general, she's only moderately anxious about her needles, so this is puzzling. We'll be following up with her GP and with resources available to us at the hospital to figure this out.

    Thank you again for your replies, it means the world to us.
     
  7. KHS22

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    Oh Man that stinks. So sorry you are going through all this.

    I would agree, try to test during an "episode" if possible. Though, it sounds unlikely that she's low. If she starts out at 16 or so and you've just given the shot, it wouldn't come down that quick. BUT, worth checking to be sure! Since she's newly diagnosed especially BG can be quite unpredictable.


    Otherwise I agree, if blood sugar is normal during these episodes - best to check with your paediatrician. Has she been checked for hypothyroid when she was first diagnosed?
     
  8. vdamico

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    Just an update: Several months in, the injections are still so incredibly difficult for her. We haven't had a repeat of the shaking with cold, blue skin since my last posting here, so we haven't had an opportunity to check and rule out a low. Her BGs in general are very "logical," if that makes sense, so I do think it was anxiety and not a low.

    She's had her thyroid palpated but we were told the thyroid and celiac labs will be done in her next clinic visit bloodwork. Is there something about low thyroid function that might cause "episodes" like this?

    Thanks again to everyone who replied!
     
  9. Christopher

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    So did you speak with her pediatrician about this issue?
     
  10. shannong

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    I'm wondering how much time delay there was between her morning glucose reading and when she had breakfast. It's possible that her blood sugar was dropping, so I would definitely check her blood sugar as others have suggested. Also, you might want to look into getting a Dexcom, especially valuable for a child so young that can't tell you that she is low.
     
  11. wilf

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    my bet is she was low, never mind the exotic conditions..
     
  12. joshualevy

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    Years ago, when my daughter was 18 months old and on shots, we used something called an "Injectese". It was a plastic holder for the syringe, so you could not see the needle go in. When we got it, I thought it was silly, because it just covered up the needle. But it made a huge difference. It was only a few dollars, and I would definitely try it. My daughter was much calmer when we used it.

    Joshua
     
  13. vdamico

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    Yes, we had a "just checking in" visit with the pediatrician once they got the hospital diagnosis. It hadn't happened in the intervening two weeks, so the pediatrician was quick to attribute it to anxiety as well. (I know we shouldn't expect tons of diabetes-related support from the pediatrician but the visit was a bit dismissive and disappointing. We're looking for another one.)
     
  14. vdamico

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    This is what I thought might be happening, too. If it happens again, we'll check. We'd love to get a CGM but when we mentioned it to some of her medical team during one of the first few education sessions, it was discouraged. We've only had one clinic visit so far, but we'll be speaking to her endo about it at the next one.
     
  15. Christopher

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    Well, then it is quite possible that is what it was.

    One thing that you will find is that you will need to advocate for your child, sometimes loudly and forcefully, to get what you think they need. School personnel, doctors, even endos will try and push back on all manner of things. If you want something like a CGM for your child, don't take no for an answer.

    Good luck.
     
  16. Snowflake

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    Our endo also "discouraged" CGM when our daughter was roughly the same age, and relatively newly diagnosed. The endo said it was a lot of info to process as we were still learning about diabetes, and that our daughter might not like the insertion or wearing it all the time. I am glad we pushed back. The endo was just plain wrong. We learned SO much about diabetes by watching her bg patterns. Not to mention that the Dexcom allowed us to catch a lot of really extreme lows and highs that we wouldn't have otherwise. Also, CGM just became her normal because she was so young when she started wearing it, so that I don't think she'll question using it any time in the near future.

    That said, I know you're in Canada where the coverage situation and the prescription process for medical devices might be totally different than for American families? Coverage has become pretty standard for private insurers down here in the four years since my daughter's diagnosis. Maybe Canadian members can weigh in on that angle...
     
  17. cdninct

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    The various GTA clinics have very different ideas on who should use technology and when they should start. Where are you at? Others are right--you sometimes need to push for what you want. If it seems like you are always fighting an uphill battle, you can switch hospitals!

    In response to Snowflake's question, some insurance companies are very supportive of CGMs, and others reject just about every request.

    If you want local information or advice, please send me a message (there should be one from me in your Notifications box--top right corner of the page)!
     
  18. vdamico

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    Correct. Having spent a few more months with her diabetes through several illnesses, I'm confident it was a low. I'm not sure exactly how, or why, but it was.

    I don't visit here as often as I'd like but I thought I'd I post that, in case it's helpful to any other parents of newly-diagnosed children.
     
  19. wilf

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    Thanks for confirming this. :cwds:
     

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