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Treating plummeting lows

Discussion in 'Parents of Children with Type 1' started by Sprocket, Aug 17, 2016.

  1. Sprocket

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    We just passed our 3 year mark, and it still terrifies me when my DD (14) goes low fast. We have a Dexcom, she's on MDI - Levemir and Novorapid. The Dexcom has made things so much easier to predict, and treat numbers before they become a low, but there is still the odd time when she plummets and I wonder if I am treating it how others do.
    Last night, she had a cinnamon roll. I weighed it, counted the carbs the package indicated, calculated her I:C ratio correctly, but didn't factor in that we'd had a long day of shopping with a lot of walking. She quickly dropped, and her glucometer went from 15 (270) to 3 (54) in a little over an hour. I gave her a cup of ovaltine (20 carbs) at about 8mmol when I saw the big drop on the dexcom - kept dropping, then 24 c. of juice ...still testing and dropping, 14 c. of rockets (smarties)...still dropping and another 24 carbs of juice. Her reading finally started rising.
    I know the books (and I've read lots of them) say to treat with 15-20 carbs and wait 15 minutes and recheck, repeat if necessary. I am quite sure if I had done that she'd be on the floor and I'd have had the glucagon out. She only went up to 11 (198) after all these carbs, so I can't imagine how low she would have gone without that heap of carbs.
    I am just looking for anyone else's strategy when faced with a fast drop. Do others over-correct, then give a correction dose later? We are both pretty on top of things as far as day to day management, but I don't know if I will ever get over the panic that sets in when this happens! Last time it happened, we were on a cruise ship about 11:30pm. Now that's stressful.
     
  2. quiltinmom

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    Sounds like you handled it beautifully. The only thing I would've done differently is to lower basal, which of course is not possible on mdi. Dexcom is a game changer with lows like this, isn't it?

    You could go the over treat then correct route, but then you're having very fast swings which isn't ideal. May be necessary sometimes, though.

    As for the panic...I don't know if that really goes away. It's par for the course for moms, I think.
     
  3. cdninct

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    It looks like you did what you had to do!

    Did you give her the Ovaltine before she got too low, not expecting the dip to be as severe? Because I don't think it would work very fast for my son, with the fat and protein in it, but it is definitely the sort of thing I would consider giving to head off a slow decline. For a true low we would stick with the faster carbs (Dex tabs or dextrose powder, or juice) until the low started to turn around and then go for something with a bit more staying power, if needed.

    That 15-15 rule is a good starting place, but that's about it. We're on the other extreme: 15g will typically bring my son up by over 8 mmol, so I would only give that many carbs if I was sure that he had too much insulin in his system!
     
  4. jenm999

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    Agree with the others; you did great. I too might have chosen faster carbs up front but hindsight is 20/20. Just wanted to add that shutting off basal does not really work for us (moot in your situation I know) - I have shared this many times before but my son once forgot to put on his pump after a shower and his BG didn't budge for THREE HOURS. I'm kind of mystified how the threshold suspend feature is all that effective; it just takes way too long for the basal insulin to clear his system.
     
  5. Sprocket

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    Yes, my choice of Ovaltine first was because I noticed the rapid drop when she was 8mmol and thought I might catch it in time. I found out quickly it wasn't going to cut it. In hindsight, I should have started out with juice or Dex 4's and followed up with the Ovaltine. Ovaltine is our standard heading low treatment at night, but it's not fast - but ideal for a steady decline.
     
  6. cdninct

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    Thant's what I figured, but I thought I would ask!
     
  7. cdninct

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    Agreed! I know it works for others, but it does zilch for my son--unless you count causing a stubborn rise about 4 hours too late!
     
  8. Nancy in VA

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    I don't think the 15/15 rules applies when you have a Dex. Because you can see what's happening in practically real time. I agree I would probably have done rapid carbs (juice) then followed up with fat/protein (Ovaltine) but without the ability to turn off the basal, you have to just keep treating until you see the upswing. We've had days like that on the pump with multiple treatments and having to turn OFF the basal for an hour or so to get her up, so I definitely get it.
     
  9. sszyszkiewicz

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  10. MomofSweetOne

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    We see fast plummeting lows if we forget to reduce bolus amount after exercise. It takes far more carbs than it would usually take to treat the low based on the Insulin On Board (which you don't have on MDI), often more than the bolus was even for. We try to reduce the bolus based on how intense and how long the exercise was, but it's so easy to forget with all the factors diabetes is affected by.
     
  11. dpr

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    So much in diabetes care is about what works for your child. What you did worked out perfect. I would do the exact thing again in same circumstance!
     
  12. forHisglory

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    The same exact thing happened to us last night. He had a 1/2 cup of ice cream for dessert (full fat) and my husband forgot to extend out the bolus. It took way more carbs than what we had bolused for to get him up. I don't understand it. Frankly, I'm worn out. It seems like his diabetes is getting harder lately. Lows and highs are more stubborn....ugh.
     
  13. kim5798

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    I really like the ovaltine suggestion. I haven't used that in a number of years, but am thinking that this could be a good option for my daughter while away at college. Perfect before bed after a day of exercise snack!
     
  14. Sprocket

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    My kids love it and it's so full of vitamins and minerals. We all have a warm ovaltine before bed.
     
  15. jenm999

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    I'll be honest. I have never had Ovaltine! I only know it from the Christmas Story movie!! We buy the shelf stable chocolate milk boxes and keep them in our room for middle-of-the-night lows. We waste a lot, unfortunately, because he only needs 2 oz. or so to come up.
     
  16. Sprocket

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    The ovaltine has 5 carbs/tablespoon. I add more or less to milk depending how much/how fast I need to bring up a low.
     

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