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Please carry glucagon, you never know...

Discussion in 'Parents of Children with Type 1' started by missmakaliasmomma, May 9, 2014.

  1. Snowflake

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    Generally, I would be inclined to take the eyewitness testimony of a caregiver at face value. The stored 31 reading seems pretty conclusive to me!

    I have seen my 4 yr old daughter's bg plummet at an alarmingly fast rate, once even after a low treatment (although she's never passed out, and we've only ever had to do low-dose glucagon one time). It sounds like you have other issues with your nurse and school administration, but that she did the right thing here.

    We always carry glucagon, but this thread has been a good reminder to me to renew our RX, as we just passed another anniversary last month.
     
  2. DavidN

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    I am very glad your daughter is ok.

    Please don't take this the wrong way, but do you think the bolus was just too big? Most of you have more D experience than I do so I'm trying to learn from this.

    I would venture to guess if my son's BG were 96 and he 20 minute prebolused 3.5 units, he would go low. Add to the equation that your daughter is away from home and can't feel her lows, was this just too aggressive?

    Is that large a pre-bolus pretty standard for most of you when BG is at 96?
     
  3. missmakaliasmomma

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    No, she normally doesn't have that big of a bolus and that's what we think happened that day. She's only 38 lbs too. I've never seen novolog to work that fast though, I'd expect that with apidra. She also needs more insulin at school, maybe that day she was a little more sensitive to it. So yes, too aggressive.
     
  4. Wren

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    My dd is in puberty, and we routinely pre-bolus (at home, not at school) 8 - 10 units - but not if there is insulin on board. A year ago, we might have used 8 - 10 units all day. It took awhile for us to understand that the breakfast dose can still be working at lunch and cause lows soon after the lunch dose is given. When we left the hospital and were told to do a correction dose if she were high 3 hours after the last dose, we thought insulin acted for 3 hours. In fact, insulin generally acts longer than that (4 -5 hours, depending on the person, the insulin, etc.) Add the tail end of the breakfast dose to the beginning of the 2nd dose, and you can go low before or soon after eating. Pumps of course should take IOB in account, but it's a setting that has to be entered and it's not perfect. The book Pumping Insulin by John Walsh has an informative section on this.
     
  5. hawkeyegirl

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    When did the reading of 31 occur? That's the first I heard of that.

    The LO reading should be in the history.
     
  6. mmgirls

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    WOW I would not expect at 38lb 5-6 year old to have a lunch ratio of close to 1:16, maybe for breakfast but not afterwards. But maybe your basal is low during that time and I:C ratio a bit stronger to get the right balance. But that can become problematic with more carbs are consumed because it becomes evident that the ratio is to strong. So I would just keep that in mind, maybe the regular amount of lunch carbs are ok but any additional might need a higher ratio?

    (She is the same size as my youngest that is not on insulin yet)
     
  7. DavidN

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    There's the answer to my question.
     
  8. hawkeyegirl

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    We prebolus at school (if his BG is above 100, I think), but he goes straight from the nurse to the lunchroom. We'd have an unholy mess if we waited until after his lunch to dose him.
     
  9. MamaC

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    Glad your daughter is OK.

    I'm OK with the administration of Glucagon for the presumed low and with gluc first/check after; not so OK with what seems to be a very shady summation offered by the nurse. I think someone is playing by CYA rules.
     
    Last edited: May 12, 2014
  10. DavidN

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    Yes, my son boluses before he eats, but only by a minute or two. We definitely can't wait until after he eats or all hell breaks loose. When I say pre-bolus I'm thinking 15-20 minutes, but technically I guess we pre-bolus as well. There are times (high BG) that I'd definitely like to pre-bolus by 20 minutes or more, unfortunately the hassle factor for my son has made this a challenge.
     
  11. DavidN

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    Our school nurse has flat-out stone-cold busted lied to us on more than one occasion.
     
  12. C6H12O6

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    "HI" does, and it downloads too (but my experience is with other meters)
     
  13. missmakaliasmomma

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    No bolus for breakfast that day, eggs. Just a little correction of .25u. Surprised I actually remember that amount.

    Wouldn't it be like an error? I've never seen hi or lo so I really don't know. Maybe it's different with certain meters?

    I know, the I:c is crazy but it's 1:18 at breakfast so not too far off, and the 1:18 works beautifully for breakfast. Even with the insulin and the highest basal of the day, she still usually spikes after lunch.





    Regardless, she was 31 at like 11:19 which WAS in the meter so obviously she could've fainted from low bg.
     
  14. missmakaliasmomma

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    And I'm glad there's another small 5yr old lol. Everyone thinks she's so little
     
  15. hawkeyegirl

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    So: Bolus at 10:40. Lunch at 11:00. Daughter faints at 11:00. Nurse says BG is 11. There is no record of 11 or "LO" in meter. Nurse says daughter recovered "immediately" from gluc administration. But at 11:19, she's still only 31, which IS in the meter.

    Yeah, that doesn't make a lot of sense.
     
  16. wilf

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    Fascinating case study - thanks to the OP for sharing. Lots for all of us to learn from this.

    I have 2 questions:

    1) How many units a day total is she getting? Using the 500 Rule, a 1:16 g carb ratio should correspond to about a TDD of 30 units a day. That carb ratio might be a bit high.

    2) Have you checked the pump regarding the time of the bolus? Even if it was an overdose of insulin, you'd not expect her to drop to 31 in just 20 minutes.

    I hope you don't mind the careful attention being paid to this matter, and I appreciate the opportunity for all of us to learn. Hard lows can happen quickly, and anything we can learn to help us avoid them is good to know.. :cwds:
     
  17. mmgirls

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    do you often do no bolus breakfasts? wondering if that could have been a contributing factor if your basal bolus is not actually matched to basal/bolus needs.
     
  18. Megnyc

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    Is there a record of ANY BG in the meter at 11:00? I have a theory but it depends on whether or not a BG was actually taken at 11.

    ETA: I just wanted to add that I appreciate the patience you have had with all of our questions.
     
  19. DavidN

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    Just want to echo this. Lots of people would be offended or put off by the feedback. They shouldn't, because we all know this is an imperfect science, but they do. Thanks for sharing. I'm wondering how it turns out.
     
  20. coni

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    How can you be sure she ate lunch at 11:00?

    What if the nurse pre-bolused at 10:40, no food eaten for whatever reason (nurse forgot or not paying attention), child drops low, BG tested at 11:16 at 31 (36 minutes after a large bolus), THEN glucagon given.

    Does you daughter remember anything? Does she remember eating before she went low?
     

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