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The rebound debate...

Discussion in 'Parents of Children with Type 1' started by MelissaC, Mar 22, 2009.

  1. Nightowl

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    Heather..."rebound" or the Somogyi phenomenon was originally hypothesized to be a human biological phenomenon that took place at night when a diabetic dropped low. No soccer was being played. It was hypothesized to take place in adults and children. They have the same metabolic pathways. I believe the second study only involved children. No doubt the body does reacts to adrenaline with increased blood sugar while taking a test or participating in a swim meet. That is an entirely different phenomenon.
     
  2. Ali

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    I have loved reading all this. Maybe the liver does not push out more glucose in response to a low but maybe the body just becomes very insulin resistant or burns fat in response to the stress of a low. Thus the highs after a low could be a result of "not enough insulin". People talk about the highs from the stress of tests, some sports , along with female hormonal effects, etc. so maybe the stress of a low has this same effect? Very interesting and as we all know "YDMV". As stated before the real trick is avoiding the whole mess to begin with. Something I am still unable to do even after many, many years.:)Ali
     
  3. Nightowl

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    You are right Sportsrep about proving a negative. Unfortunate choice of words on my part. I think different posters are talking about different phenomenon in this thread. "Rebound" as hypothesized by Dr. Somogyi argues that when one injects too much insulin during the day and then experiences a drop in glucose during the night that the body will rebound by releasing glucose - like a metabolic glucagon injection. This is a terrible disease. A frightening disease. It's important that we know what players are on our side. Believe me, I would love to be able to take some comfort in knowing that if my son shoots too much insulin that rebound would jump into action. There has never been any scientific evidence presented to support this theory. All the evidence gathered and reported refutes it. I think it is important for people to know that there is no scientific support for rebound so that when their child experiences an extreme high, instead of attributing it to rebound, they can look for the real cause.
     
  4. Darryl

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    These kinds of personal attacks are happening all too often in this forum when parents who
    use CGM's report findings that differ from the various "effects" and "phenomena" that are the
    commonly accepted folklore of diabetes care.

    Nightowl presented three scientific studies, which are the only studies anyone has posted here
    regarding rebounds and symogi effect. Yes, one article was 65% women (not sure why that matters)
    and they were adults (which might matter), but none the less it was a scientific study of 600 T1D's.
    The other article studies 81 T1D's.

    Nightowl's point, I believe, was to warn parents that the so-called "rebound" effect should not be
    counted upon as a safety mechanism. I think this was a perfectly valid point in response to several
    posts above that say "Rebounds definitely do happen". A new parent reading this thread could take
    "definitely" the wrong way and interpret it to mean that overnight testing is not required becuase
    rebounds "definitely" will happen.

    Rebounds probably do happen sometimes, in some children, and some of those rebounds are due
    to the body self-regulating when in distress, whereas other rebounds are due to (as the poster so
    eloquently posted above "stuffing one's face") or simply because basal needs change dramatically
    on a moment's notice which could easily explain any low becoming a 300+ if not caught and treated
    early enough.

    I do not understand Heather and Wilf's personal attacks towards Nightowl. Yes, Nightowl made a
    strongly worded post backed up with 3 research articles, yer her post never attacked any other
    CWD member. She deserves the same respect in return.

    In my experience since monitoring D 24/7 for 2 years with a CGM, most of the diabetes folklore
    put forth in books like Hanas is pure nonsense, made up to help people think they can rationalize
    the randomness of D. As Nightowl stated above, acceptance of one "pheonomena" or another as
    the reason for highs and lows could divert people from exploring and effectively treating the real
    causes.
     
    Last edited: Mar 27, 2009
  5. Heather(CA)

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  6. Darryl

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    This is the kind of thing I am talking about. A new parent who reads this thread could take false comfort.

    I am not disputing that rebounds happen in some kids. They might. Rebounds never happen with my child,
    even before the CGM when she'd have a BG in the 30's and be shaking like on the verge of a seizure. In my
    opinion, parents should always remember that hypoglycemia can be fatal, and should never assume that
    "rebounds happen".
     
  7. ecs1516

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    Yes, this is what kind of rebounding we see on the CGM.
     
  8. ecs1516

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    How long would a 'natural' rebound take? My son was BG 38 for at least 25 minutes on vacation and I was giving gel , juice, tablets to get him up. Nothing worked until I gave a mini glucagon.
     
  9. Darryl

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    In my opinion, managing D for 13 months using a CGM brings at least as much
    enlightenment as managing D for several years without. The main thing I've learned
    in managing D for 2+ years with a CGM is that every so-called "phenomena" and "effect"
    in the folklore does really happen - 50% of the time, that is. The other 50% of the time
    the reverse happens. I think that parents should be aware of this (the "rebound" effect
    being only one example of a 50/50 proposition).
     
    Last edited: Mar 27, 2009
  10. Mama2H

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    Let's remember to be kind to one another :cwds: We all feel strongly but I hope that it can be agreed that we cannot depend on a rebound happening. I *think* that is what some are trying to point out. We would not want a newbie to think that lows will fix themselves so we don't have to worry about them.

    Remember, we are all on the same team here :eek:
     
  11. Darryl

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    I don't know if there is a "natural" rebound. People with T1 can be severely injured
    or die from untreated hypoglycemia.

    The only natural rebound theory I can buy into is in the event of seizure (or similar
    distress), some hormal response (possibly adrenalin) can trigger release of glucose
    from the liver. This is not the normal pathway of glucose regulation that takes place
    in a non-D person, where the alpha cells are still working. But this pathway may exist.
    Think of it like the airbag in a car. It might deploy, and if it does, it might save you,
    or it might not.

    The prolonged 38 you mentioned might have resolved without the glucagon, as carbs
    you gave don't digest instantly and might have taken more than 25 minutes to
    counteract the excess insulin that brought BG to 38 in the first place. However, after
    25 minutes you probably did the right thing to be safe!
     
  12. moco89

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    Rebounds DO occur. The is no if, ands and buts about it. The JDRF has done studies about it.

    There was a JDRF study done about this, and it essentially said:

    There is a protective role with hormones when one goes low, just like somebody without D. The difference is when it happens to somebody with D, the body overcompensates with hormones to counteract the low glucose because of a loss of communication (cell signaling) between the endocrine system. This loss of efficient communication occurs about three years after diagnosis, as I recall.


    I do agree that there is overcompensation in general with carbs to treat lows, and that will cause highs for some people.
     
  13. Sarah Maddie's Mom

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    We all know how strongly you feel about the value of CGM but can you not see that this is a serious slap in the face for every parent here who has developed great expertise in managing their child D without a CGM?

    Are you folks now the only arbiters of "the truth" on CWD??
     
  14. ecs1516

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    The BG was a result of a lot of walking (Disney) and guessing wrong on a crossiant with fat and feeling bold with the CGM and giving a little extra .15 to bring down a 219 blood sugar.:rolleyes: With all the juice , gel etc. he still was becoming more and more unconscious. I said the heck with this and gave him the mini-gluc. Yea, he had a rebound from that later but I didn't care at that point.:p
     
  15. Darryl

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    To clarify the JDRF study -

    What level of BG did the study find rebounds to occur?
    Was the rebound "100%" or observed only in some people?
    Was the study done on children, adults, or both?
    Is there an online link to the study?
     
  16. Darryl

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    I think I am beginning to see the problem here. Look at my statement.
    I said "at least as much". Not "more". And this specifically in reply to
    Heather's comment to Nightowl that she knows more about D because
    she's been at it for 6 years vs. 13 months.

    It seems like anytime someone here who uses a CGM reports data, those who
    don't use a CGM consider it an insult. Or a "slap in the face" as you put it.

    If you read the posts above in this thread, it appears to me that those who
    don't use CGM's come accross as the arbiters of the truth, using statements
    like "definitely" as if it applies to everyone. Read my posts: Even when
    discussing my observations using a CGM, I am careful to say "in my experience"
    and with regard to "my child".

    There is no point in insulting those who do use CGM's for posting our findings
    and drawing conclusions. People who don't use CGM's post their findings and
    conclusions as well, with just as strong of an opinion.
     
  17. Darryl

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    You did the right thing. A 38 is nothing to take chances with.

    It also appears in this situation, there was no "natural" rebound, even after 25 minutes at a BG of 38.
     
  18. Heather(CA)

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    I don't know the particulars because it's usually because of a low that has been missed, or caught too late when a rebound happens. I would think you caught it just before it happened if the circumstances were normal, and while it took a while to bring it back up (Been there done that too) you did catch it. I just did a search, I was looking for deaths from a Hypo, the only one I found was where they were severely intoxicated...:(
     
  19. Heather(CA)

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    I'm not going to debate any further whether rebounds are real or not. I do want to state why I think it's important to know about them. It's not so that you can ignore lows, or not test when you feel it's necc.

    It's so that you have more knowlege when dealing with D, it's hard enough without knowing everything your up against...

    For example, lets say your child goes to bed at 112, then wakes up at 302.
    When I say go to bed, I'm talking about the last test after all the fastacting is gone in your particular child....I always test after the fastacting, then compare THAT number with the morning number to adjust the Lantus.

    What are some of the reasons for the 302??
    A. Growth spurt?
    B. Getting sick?
    C. Snuck something?
    and
    D. Rebound?

    How do you tell? You can't for sure yet, start with trusting your gut..

    Growth spurt? Have they been eating a lot? Do they seem extra tired?
    Getting sick? Any sniffles? cough? fever?
    snuck something? Any wrappers in their bed??
    and
    rebound? Did they have extra activitly the day before? Has the weather gotten a lot warmer? Did they just get over being sick or a growth spurt?

    If your gut is telling you A,B, or C then give a full correction. If your thinking D. add everything up then subtract 1 unit. If it comes down, it was probably a rebound.

    Then, that night, if your still not sure and want to find out, it's time for extra testing...That's the only way to know for sure...
     
  20. betty6333

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    I also do not want to debate, because all these hard feelings seem to be unproductive. I did want to add that while I have seen many highs followed by lows, I have never seen a low for my child correct itsself. He has had too many lows and we have been using the CGM since last august, and in that time i have never seen a rebound. If he is under 40 and I do not catch it early, he will stay that way, unfortunately his body doesn't seem to do that.

    I am not trying to say anything about anyone elses life, child or experiences. We have not been "lucky " enough to experience a rebound. For us, if he goes low he stays low until he is fed carbs. This is just our experience.
     

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