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Low melt downs and tantrums with a 2 y..o

Discussion in 'Parents of Children with Type 1' started by natallia, Oct 28, 2013.

  1. natallia

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    My 2 y.o. T1 is a "baby from hell", as someone described him once after watching him for a day. On top of being an extremely picky eater, he is the classic "terrible 2s" times10. I have other children and never have encountered such extreme tantrums and melt downs. He hates juice, milk and any other drink or sweets (no ice cream, candy, or sugar of any kind) and only drinks water. When he is low (anything below 4) he gets super cranky and will push, bite and kick me like there is no tomorrow. Treating lows is almost impossible, unless I have his dad holding him in a headlock and I would spray some dex gel with a syringe into his mouth and hold his jaws together so he wouldn't spit it out. So when I am alone with him and we have a low episode I am terrified! I am really at the end of my wits and have been using mini shots of glucagon on a regular basis because its the only way. I guess my question is maybe some of you with small t1 kids know some tricks I can try. Please help!
     
  2. Nancy in VA

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    Have you considered a CGM? If you get a CGM, then maybe you can head off some of the lows by catching them when he's still higher and you can treat with food he'll eat instead of the more urgent lows. Sorry I don't have a lot of tips because I'm fortunate that my T1 will eat basically anything, which is helpful since she's also celiac!
     
  3. natallia

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    Thank you, Nancy! We actually have been using Dex since he was 11 months old. And it def. helps to avoid a lot of lows, but he still has at least two lows per week when I am simply not able to treat it before it becomes a true low. It usually happens when I am by myself with him and simply can't get him to eat anything. And its just getting worse. A low in the upper 20s is not uncommon for us anymore. :( It s so scary!
     
  4. natallia

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    Also, I used to prebolus him for meals. I can't do it anymore because I don't know how much he will eat or IF he will eat at all. As a result we have a huge spike in the 300-400s about an hour after meals, especially breakfast. His a1c went up from 6.2 to 7.6 in just 6 months. We are pumping with Omnipod. Our endo is very sympathetic and helpful and always tell me it will get better as he grows. He gave me an Rx for 20 glucagons with repeats, but somehow it feels wrong to use it so much. When? When is it going to get better?
     
  5. Sarah Maddie's Mom

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    Well, I'm sitting on the sidelines (not having had a 2 year old with D) but from the outside I'm thinking maybe you would want to consider loosening your "control" just a bit for a period of months to give him a chance to grow out of the phase and to lessen your stress within the family? Maybe his target bg could come up by 10 or 20 pts just for a while and with your endo's assistance so you could give him a break from the lows and the struggle?

    Like I said, just a thought from the outside.

    Good luck. It sounds really hard.:(
     
  6. natallia

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    Thank you! That's what our endo suggests too - to loosen control for a little while. But its hard to accept an a1c of 7.6 after 6.2 I guess. I am predicting the next one to be well in the 8s. It is a huge stress for me and def. my other children. What a mess!
     
  7. mmgirls

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    I will suggest the same thing, aim for a higher target and if need be give more smaller corrections rather than a larger correction that can go below your target and cause a low.


    Is there any rhymn or reason to the lows? do they happen more often after meals boluses or just after meals with corrections? out of the blue?

    Maybe he needs to have a higher basal to makeup for the no prebolusing and less insulin for meal coverge? You can manipulate insulin to work for you rather than against you especially when dealing with a toddler that is picky and a target that is very low.
     
  8. Sarah Maddie's Mom

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    Try not to let the A1c loom so large. Since my dd was dxd we've probably had 30 A1cs - some great, some down right ugly but the A1c that broke my heart 9 A1cs ago is a distant memory - the now matters and that's the now of the numbers and the now of the child's overall wellbeing. :cwds:
     
  9. TripleThreat

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    I am sorry you are going through this. I'd say decrease the basal rates. Adjust his settings so he runs a little higher. Give the family and his liver a break and especially the little guy. An a1c is not our grade a happy healthy child is what we should strive for.

    Take a breather relax it will work out he will want to eat again.
    Have you tried any combo bolus methods.
     
  10. missmakaliasmomma

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    I don't really have too much I can personally add unfortunately. My daughter was dxd at 17 months but she took it really well, she's always been a good listener and all around a good kid. I got lucky with her. I'm sure my son will give me hell when he turns two though.

    His tantrums could be that bad because he's feeling the changes in his BGs but can't voice how he feels, so he lashes out. I have heard of older t1s that get angry when low and just can't control it.

    About the issue with prebolusing and the spikes. When we were using humalog, we'd see those spikes all the time. It wasn't until I found out about Apidra on this site did I decide to try it out to see if it would make a difference. While my daughter's been on apidra, the spikes have been minimal (compared to before). I also utilize prebolusing a lot more now than I did before, but that's because she's 5 and a good eater so I know she will eat everything I give her.

    I prebolused her this morning (always before breakfast!!!) and at the height of the carbs starting to digest, her BG was 156. She started at 128. Apidra has been a very good change for us so far. I saw high highs on Saturday but that was because she had a birthday party with pizza and cupcakes yay :rolleyes:

    For his age, an a1c of 7.6 is fine, lows in the 20's though, that frequently, I wouldn't be ok with. If he was diagnosed not too long ago, that a1c of 6.2 could've been a honeymoon a1c, and those really aren't accurate as "full blown" diabetes hadn't really hit yet.

    I would try to find some stuff he likes, I feel like there has to be some sugar he likes.
     
  11. natallia

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    thank you so much, Kristen! We do use Apidra and love it. But still get spikes especially after breakfast. Our Dteam says he must be just super sensitive because of his age. He was diagnosed at 9 months old so the honeymoon is definitely over, and the first year was perfect, great control, no crazy spikes and hardly any lows, all a1cs in low 6 without even trying. I will try to aim for a higher target ( it is 6-12 right now 120-220) though...
     
  12. mmgirls

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    that is not really a target, that is a range.
     
  13. missmakaliasmomma

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    Diabetes is so up and down. You'll have a week of great BGs and the next week all hell breaks loose.. and you didn't even do or eat anything different. the human body is a crazy thing and I like to think that it just does what it wants to a lot of the time. What is he eating for breakfast? Breakfast is our lowest carb meal because it's the hardest to control spikes, plus never any cereal (it's the devil for us)

    I of course assumed that you weren't using apidra since, here, I think it's approved for 4 years old and up. I know things differ a lot in other countries though.

    ...Everyone asks me how I knew my daughter had D because she was so young when diagnosed but how the heck did you find out your son had diabetes at only 9 months!?
     
  14. nebby3

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    So I have had a 2 yo with D though it has been a long time. I would have been happy with a 7.6 then though. I agree with others about trying to avoid the lows. Do you notice behavior problems with highs though too? I wouldn't feel bad at all about using glucagon frequently. It sounds like your endo approves and you are getting it covered by insurance. Our own bodies use glucahon to regulate bg and so will an artifical pancreas. It is a great solution.

    It sounded from your initial post like this is more than a D problem. I mean, that he acts up other times too. Is that true? I know it has been hard for me with a little one with D not to baby her some and cater to her when she acts us (speaking in the past; she is 11 now). So I don't know you and this may completely not be true in your case but I wondered if it is possible you are not disciplining and letting him get away with tantrums and other bad behavior when you wouldn't have done so with your other kids. Now I wouldn't discipline when his bg is 20 but I would other times and I would talk to him afterwards about how that behavior wasn't acceptable no matter what his bg. I know it may not do much good at his age but maybe over time it will sink in.
     
  15. MomofSweetOne

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    Since he's so little, could you get away with feeding him lower carb foods to minimize the spikes and lows? Cheese, eggs, green beans, etc.? I can't imagine how dreadful he must feel with those high spikes. The small eating, pickiness sounds like normal 2s, but with those high spikes and fast drops, he must feel terrible. My daughter says fast drops from higher numbers are as bad as lows and worse if she actually hits a low.

    Do you have your low alarm on the Dexcom set as high as it can be?
     
  16. mmgirls

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    Many Dr.s prescribe "offlable", thank god for that otherwise we wouldn't have Dexcom either.

    My answer to how did I know was simple: she got very very very sick and it got worse befor it got better.
     
  17. natallia

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    you are right! His target is 5(100) during the day and 6 (120) at night. Is it too low?

    How did I find out that he was diabetic? Well, it was rather frustrating. As a mom I knew there was something terribly wrong with him in spite of what doctors were telling me. He lost o4 lbs in just a few weeks which was not normal for 8-9 months baby. He had a diaper rush which seemed to never go away and he was always thirsty. Of course our doctor kept brushing me off saying I worry too much, because my son looked "very happy" and wetting diapers because he drinks too much. I should limit his drinking. So I googled it. And diabetes came up somewhere in the search and so I called the doc and asked for glucose test and he said Sam was "way too young" to have diabetes and why am I so worried, like a first time parent?! I went to the pharmacy the same morning and spent a $100 on a testing kit anyway and could n't wait to get home to test him. Sure enough he was over 500. So I just scooped him up and went to ER and called my doc on the way and called him a-hole. Sorry, this still makes me so angry, my hands are shaking as am typing it, even after almost two years of our "new life"
     
  18. missmakaliasmomma

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    We had almost the exact situation happen. Diaper rashes, so thirsty. She wasn't sleeping well also and was just not herself. The dr at urgent care told me she was fine and that she wasnt dehydrated because she had tears. Told me she didnt have diabetes but would take her blood like I asked. Got a call at 6 am the next day telling me to get to a hospital right away because of course, her sugar level was too high. It still makes me mad to this day. I wanted to write a letter to the practice because i was so mad but my mom convinced me not to, saying it would only make me more mad. From that day on, I lost a lot of faith in doctors. instead of listening to the parents who know their children the best, they go by what their stupid books say.

    I think his target might be too low. I want to say my daughter's at that age might've been around 150? We've lowered it every year and now that she's 5 her target is 120. I'm not comfortable with 100 or under because she's still very insulin sensitive so she can drop from 100 to a low number very quick. She is frequently between 100-150 though.

    I would try a pretty low carb breakfast and do the bigger carb meals for lunch and dinner. It works pretty well for us. On school days, breakfast and lunch are about the same amount of carbs which is around 20g ( I try very hard to keep her BGs good at school because the nurse can't do what I do ) and then dinner is the biggest meal.

    It took us awhile to get the hang of it... Probably longer than most. I'm happy where we are now. i don't think I could've been in this place right now if 1. We weren't using apidra 2. i wasn't prebolusing for breakfast and 3. making much smarter food choices- the more whole foods the better. After almost 4 years, I've also relaxed a lot. I used to take highs way too personal. Every bad number I felt was my fault, like I could've done something different. Now having to divide my time and energy between a 5 yo with diabetes and a 3 month old, I HAVE to relax, or I'll go nuts.

    I would definitely try things to even out his BGs and see if he starts to act a little better. Highs and lows are not fun for anyone.
     
  19. MomofSweetOne

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    My daughter has those same targets (age 14, capable of feeling and treating lows herself), and the 100 makes our team a bit nervous. If I were you, I'd probably try a daytime target of 120 for the days as well to see if you can avoid some of the combativeness with lows. I'd have the CGM alarm set to 100 and boost with a couple carbs at that point.
     
  20. mmgirls

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    I personally think that that is a very aggressive daytime target with a 2yr old that is so hard to treat a low.

    I would consider having 1 target bg of 125 for the whole day.

    I know you said your range was 100 to 220, but how do you have the POD setup to do corrections? Do your correct to target BG of 100 during the day or do you not correct until above range of 220? how often do you correct?
    Do you reverse correct?
     

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