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Thread: Question about lows

  1. #11

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    Quote Originally Posted by barbiduleny View Post
    As a side note, i find it baffling that they would recommend suspending basal on the pump as a regular thing to treat a low: by the time that suspend actually has a meaningful effect, it's been an hour and half. Seems like a recipe for bouncing back to a high and getting stuck in a pattern of highs and lows.
    I totally agree with this. We do sometimes suspend in extraordinary circumstances -- for example, if dd is sick, low, and having a hard time eating, and we've been trying to get her bg up for a while with no success.

    Suspends take a LONG time to affect the bg and then, when we do start to see the effect, as often as not it's a rocket high that is hard to bring back down. Suspends are not a day-to-day management tool, IMO.
    Snowflake
    Mom to
    DD TR, age 6. Dx-ed with T1 04/04/2012. Omnipod & Dexcom user. Dx-ed with celiac 12/23/2013.
    DS1, age 4
    DS2, age 1.

  2. #12

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    Quote Originally Posted by WestOfPecos View Post

    I did some quick research a few days ago. So far, research shows that lows do not have a long term effect on the brain.
    That study was of teens and adults.

    I do recall that there are a fair number of studies show subtle cognitive differences in very young kids who experience frequent lows. Some of these studies aren't that helpful for assessing the impact of frequent mild lows, since they only look at severe lows and seizures. And I'm not sure how applicable studies from the pre-CGM era (that assume a lot of undetected hypos in the little kid population) are to families that manage small children with CGMs nowadays. However, the evidence is worrying enough that this brain development issue is pretty much the first thing our endo brought up at our then-2-year-old daughter's first clinic visit after her diagnosis.
    Snowflake
    Mom to
    DD TR, age 6. Dx-ed with T1 04/04/2012. Omnipod & Dexcom user. Dx-ed with celiac 12/23/2013.
    DS1, age 4
    DS2, age 1.

  3. #13

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    Wow, your endo team seems way too aggressive about lows. We came home with the protocol of treating with 4 g, waiting 15-20 minutes, retesting, and repeating. Our son is a toddler. 15 g would send him to the stratosphere.

    Also, in general I think endo teams are too focused on avoiding lows. My guess is that's because they got their training before CGMs were widely used or understood. Without a CGM, a person can be low for hours without treatment, and the risk of seizures is much higher. With a CGM you can head off most lows almost completely.

    Very few studies have looked at the impact of brief, mild-to-moderate lows as documented on CGM. One small study found moderate, frequent lows may be associated with disordered nerve conduction to the heart, but I think it used finger pricks to confirm lows. Other studies show mild cognitive impairment in very young kids experiencing frequent lows. But again, those weren't with CGM if I remember correctly. It's hard to map between, say, 3 lows a week that are shown on CGM and total less than an hour, and two finger-prick lows that mean a person could have been even lower for many hours and just not known it. Also, the CGM in our experience frequently overstates the lowest of the low. Maybe the lowest our son hits on finger-prick is 55, but CGM says 40 for 20 minutes.

    And keep in mind that kids running elevated A1Cs -- even those below the 7.0 guideline -- show brain abnormalities and subtle deficits in learning and memory in tests as well. So it's just a crummy tradeoff we all have to make. If only there was a way to protect our kids from all these complications -- we need faster insulins, better treatments and a CURE!
    1 2-year-old T1D boy
    pumping Minimed 523 8/16
    Dexcom G5 5/16

  4. #14
    Join Date
    Aug 2007
    Location
    Hamilton, Canada
    Posts
    9,599

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    You are doing fine and the medical professionals you were dealing with come off as a bunch of nervous nellies.

    In Germany where we got our training parents are told that if your child doesn't get into the 50s at least once/week that you are running them too high..

    There is no known issue regarding lows affecting brain development. I should note that as a distance runner I went low on a regular basis in my high school and university days with no effects on my brain.

    By comparison, there are well known complications that arise from too-high blood sugars.
    ________________________________________
    Wilf

    Proud Dad of Amy (19), diagnosed Aug. 2006 and getting MDI of Apidra, Regular and Lantus..
    and Sylvie (15); very happy husband of Shirla!

  5. #15
    Join Date
    Feb 2014
    Location
    Pacific NW
    Posts
    1,301

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    Quote Originally Posted by wilf View Post
    parents are told that if your child doesn't get into the 50s at least once/week that you are running them too high..
    I'm a firm believer in the above.
    Mother of two wonderful daughters:
    *T age 14 - dx'd 01/24/2014 at age 11.5
    MDI: Humalog & Lantus 01/24/2014 - 06/04/2014
    Dexcom: G4 05/02/2014; G4 with Share 03/11/2015; G5 10/07/2015
    OmniPod with Humalog 06/05/2014; Apidra 09/12/2014
    *C age 27 - reactive airway disease; married 08/30/2014

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