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Severe Hypo and turning Blue

Discussion in 'Parents of Children with Type 1' started by SarahsMum, May 10, 2009.

  1. SarahsMum

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    Ok so as you know Im new to this whole wife world of Diabetes but something happened last night that has never happened before.

    We went away for the weekend. DH was already there and I drove down later in the day, the drive was 1.5 hours.

    I checked Sarah's BSL before we left and she was 8.8, upon arriving she was acting hypo (she becomes very unsettled and then either sucks her dummy for dear life, or sucks the feed down very quickly) so I checked her BSL and it was LO. As per our protocol I gave 3mls of sucrose and her feed. 15 mins later she was 1.1, so I gave another 3 mls sucrose and waited 30 mins - she had then dropped again to LO, so another 3mls sucrose and 30 mins later LO.

    I gave up at this point as I looked at her and her lips had gone blue:(. I got the glucagon out and as per the instructions from her endo I have her 1/2 ml, she is on a pump so injected it into her other thing.

    Pump had been suspended at the start when I first detected the hypo.

    Waited 15 mins after Glucogon and she was still LO, which has never happened, we have used Glucagon twice before and she has always started coming up after 5 mins and after 15 mins is usually back up around 6.

    Her chin, cheeks and eyes were now going blue, so drew the other 1/2 ml up and injected it.

    Finally she recovered 30 mins after the second Glucagon.

    So she was in either LO or 1.1 from 930pm-midnight.

    Has anyone experienced their child going blue with a severe hypo and how do you deal with it.

    I was on the verge of calling the paramedics but she started to pink up and respond to the glucagon.

    Oh she fed then at 3am and was 10.2 and at her 6am feed was LO again, but she responded straight away to the first dose of Sucrose and her feed and no blue episode.

    TIA

    Kat
     
  2. sam1nat2

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    I've never experienced this. I'd recommend first calling your dr. They will most likely recommend letting her run a bit higher so her liver can recover.

    Glad you were able to get her to respond to the glucagon!! Good job mama!!
     
  3. kiwikid

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    Goodness Kat - it sounds scary to me. I haven't had to deal with this either and I think I would be calling for medical help straight away. It must be hard having your husband away!

    Can your basal rates be reduced or is Sarah on the lowest pump setting available? I think your Endo needs to notified so he can review things.:cwds:

    You are doing a GREAT job. Babies are so much harder to deal with than older kids. Rachel's care has got much simpler with her ability to communicate. Hang in There - it does get easier.
     
  4. allisa

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    oh yikes.....

    I have no advice on this....but wanted you to know I was thinking of you !

    It sounds as though you did all the right things.....Little Sarah has such a difference circumstance ( being so YOUNG !! ).....I think that you are amazing....that you can see her lows !!

    Keep doing what you are doing....you are doing a great job !!
     
  5. Lisa P.

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    So glad she recovered with assistance, what an ordeal.

    I'd just echo that I don't know your situation well, and I don't know at all how this stuff works when there are no alpha cells in addition to no beta cells. But I'd echo that a baby has very few reserves and glucagon works on those reserves, if she is low for long or has frequent lows over the course of several days that reserve gets depleted and is not able to help as well when glucagon is used.

    I would suggest, although I'm sure you've got this already if it's appropriate, that you need to run her numbers higher, probably all the time. Increase your target range? My endo told me they just came up with studies saying that in little kids highs don't cause the cell damage (that leads to complications) in the same way it does in older kids and adults (I suspect he really meant they "heal"). Running a little one higher may sometimes just be necessary. It won't always be that way, it will get better!
     
  6. Darryl

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    Could you ask your endo for the source of that study and publish it here? I want to be sure that the endo didn't just "make it up" based on heresay information. The concept that high BG does not cause damage in the youngest childen is a very dangerous assumption if not substantiated by a properly conducted and controlled study of children with T1D.
     
  7. Darryl

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    Kat,

    I don't know if any of us will have this same experience, because even with autoimmune T1D, the pancreas is not fully disabled (at least not in the beginning). Your situation is similar in principle to T1D, but may be different in ways that only an endochrinologist may be able to explain.

    I'd check with your endo on what might have caused this even with the insulin suspended, and would also recommend looking into a continuous monitor (perhaps the Dexcom which has the smallest needle).
     
  8. Lisa P.

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    His statement was tailored to our situation, and simplified -- I apologize if you think I'm using it inappropriately here. The OP has a very different situation, I don't know if the advice was helpful to her or not, but if she has used glucagon 3 times in 4 months I think it's appropriate to give her some information that may help her weigh the risks of running her child's bg's higher.

    I know you don't "know" my endo and I sympathize because I've had some wacky health care advice over this year, so I'll try not to snap! :rolleyes: But he certainly has not "made it up" -- he's a professional. He also did not say highs were not damaging, he simply gave us info that highs might not be as damaging in small children as they are in older children and adults. Since we are fairly aggressive about keeping our daughter's numbers down, it was perfectly appropriate info to share with us. I'm sure if her A1C were 11, he would not have felt the need to provide that info.

    :cwds:

    I'll try to remember to ask for a citation.
     
    Last edited: May 10, 2009
  9. Flutterby

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    yikes, we've never had this happen.. it sure sounds scary.. one quick question.. you said
    did you inject the glucagon INTO her PUMP SITE??? if you did it that way, you would have pushed more insulin into her body..and she wouldn't have gotten the complete glucagon shot..

    With her being so tiny, I'd also run her a lot higher today, and the next few days so her body can build the stores again.. her body is so tiny that it can't keep that much as a store, so that first low, probably drained it, and then the glucagon had nothing to work with.. if this ever happens to you again, please don't hesitate to dial 911.. it must have been very very scary!!
     
    Last edited: May 10, 2009
  10. Darryl

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    Lisa,

    I didn't mean to come accross as questioning the professionalism of your endo. However, there is a lot of heresay about high BG's not affecting very yound children that I have heard repeatedly, from many sources, and when I have asked, no can can point to the study that supports such a theory. The DCCT (the only controlled study on T1's I am aware of) concluded the opposite, namely that the early years may be the most important. Perhaps there is a new study that just came out in the past year. If your endo can cite the actual study, it would be nice to see the source of the data.
     
  11. mmgirls

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    I am sorry that this time around she was so hard to bring up for you. You are doing great and are you are in a unique situation, far different but so similar to the rest of us here.

    The only sugestion that I could make is to initially give more than 3ml when she is reading LO and wait and verify that she is on the way up before her "feed". Her "ffed probably includes fats and protein that will slow down the absorbtion of any follow up low sugar treatments, so by waiting to make sure she is coming up first you will not slow down the absorption of an additional trestment.

    Like the others said, trying to avoid any and all lows for the next few days will allow th liver to replenish its stores of sugar so that glucagon can be used to release tat sugar.
     
  12. Darryl

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    Kat, in reading this again, I think you should speak with your doctor as soon as possible. Something seems very off with the insulin doses. I have no medical background, but from what I know when the lips turn blue it means too little oxygen and that could mean she is in a critical condition. Not that I would suggest higher BG's as a long term solution, but until you obtain further guidance from your doctor I would reduce both basal and bolus insulin for safety, and correct downward (carefully) if/when BG rises too high rather than risking an episode like this again.

    Also please inquire about a continuous monitor (CGM). In a situation like yours it could make a huge difference.
     
  13. Gaia

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    How very terrifying that must have been!! Id put a call into her endo just to be safe. They may want to examine her and possibly adjust her needs. Is she doing better today? Sending hugs your way. :cwds:
     
  14. czardoust

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    Katerinas lips were blue when she seized yes. Im so glad your baby is ok now. Please dont ever think that you should not call 911. EMT's and paramedics live to help others, they would never think it was a waste of time even if the emergency was over by the time they arrived. you have a lot on your plate. :)
     
  15. Lisa P.

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    I can see that -- but it doesn't sound like my endo to just go from the grapevine. I'll check if I get a chance. From my recollection, it seemed his reference was to something recent, small, and not confirmed. More like "it's been suggested by a recent study that maybe".

    I get trouble from medical folks in both directions -- folks insisting it's o.k. to keep my kid at 300 and folks who are shocked if she ever crosses 200. They are both frustrating, but folks who don't realize that toddlers are at particular risk with lows (they can't recognize and communicate them coming and don't have the liver stores to weather them as well) can really mess with ya. That's why I appreciate my endo saying this (assuming it's accurate, and I think he is an accurate guy).
     
  16. ecs1516

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    Darryl,
    Our endo office, Emory in Atlanta, also told us this. I will have to remember next time I am in what supports that.
     
  17. Darryl

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    If it is true, that would be wonderful, especially for the very young kids.
     
  18. Darryl

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    Lisa,

    I think when people talk about 300's, they're probably referring to every now and then. Over 240 you can get ketones, right? When people talk about 200's, they are probably referring to average BG.

    From all I have read, I would say that we'd want average BG to be well under 200, but to acknowlege that BG's over 200 are often unavoidable.
     
  19. mamamccoy87

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    I would agree - I do have medical background and turning blue is not good. :eek:Talk to your endo and find out what to do if it ever happens again. Docs are on call - call them - that's what they get paid the big bucks for.
     
  20. Seans Mom

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    I remember a post on another board shortly after Sean was dx'd from a mother of a boy who was dx'd at 6 mos. old saying her endo (they were in Nevada) said the same thing. She said the endo stated something along the lines of cell regeneration in the young protect them from the damages of higher numbers. Sorry my memory of that time isn't more clear but I was trying to jam a lot of info in at once. ;)
     

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