Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.
Q has high and low blood sugars all the time. It’s just part of life with diabetes for an active kid. Few lows or highs rattle my cage because this isn’t our first rodeo. But this particular night, I was surprised at how quickly Q’s BG could drop.
At bedtime snack Q’s CGM showed about 175 with two arrows down. By bedtime she was right around 100. A few minutes after lights out her CGM buzzed that it hit her low threshold (85 mg/dL) so I had her drink a juice box.
I laid down and turned on the TV and a few minutes later Q was at my bedside, glossy eyed.
She said, “I feel weird. I haven’t felt like this since I was little. I can’t focus on anything and I can hear my heartbeat in my ears.”
I said, “You must be pretty low. Let’s get you back in bed and we’ll check your blood sugar.”
I was not expecting to see 31 mg/dL on her meter!
This actually ties for the lowest low she’s ever had. A few years ago she came inside from playing in the snow (pre-CGM days) feeling low, but walking and talking and ready to get right back out there.
Until that point I had always assumed that at that number a child would be unconscious and in need of glucagon and a 911 call.
I snapped into action reaching for the supplies in her night stand organizer. And there was nothing that I needed in that moment. No glucose gel. The glucagon was expired.
There was a brick of juice boxes on the floor by her nightstand, but the first one hadn’t seemed to help.
I called down to my husband to grab a glucose gel. I asked him to give her the gel and sit with her. I had noticed that she had 1.65 units of insulin on board (IOB) and was afraid that her BG was going to stay stubbornly low or drop further. I used my phone to look up mini glucagon in case our fast acting carbs didn’t help, she couldn’t stomach ingesting more carbs, or in case she vomited.
And of course I snapped a few pictures while I waited a few minutes to check her again.
I had my husband go back downstairs for a box of bunny gummies and the new package of glucose gel.
While she ate a package of bunny gummies, I sent my husband down to grab more test strips, a glucagon kit that wasn’t expired, and some syringes.
At hearing the word “syringe” Q had a look of fear. It’s been so long since she was on multiple daily injections (MDI) that she balks at the thought of getting just one.
She said, “What I wouldn’t give for some peanut butter crackers.”
I rechecked her blood sugar and she was in the 70’s. I called for my husband to come walk her down the stairs, just in case she got wobbly, so that she could have some peanut butter crackers. (The “rule of 15’s that we typically follow states to have a snack with protein after treating a low if it will be several hours until the next meal.)
I didn’t want cracker crumbs in her bed!
Of course during this my son was awoken, which nullified getting both kids to bed early that night!
I knew that after having a juice box, a glucose gel, bunny gummies, and finally peanut butter crackers, she would rebound. When I checked her after a bit she was 183, with the CGM saying 175 with two arrows up.
But in the grand scheme of things I’d rather deal with a high blood sugar in the night if it meant we averted a crisis.
When I checked on her at 10:30 pm she was 233. I gave the correction that her pump suggested. And I hoped that that’s that and we would all sleep the rest of the night.
If there are any takeaways from this experience they might be:
(Remember, this is not medical advice but was my thought process in treating this severe low.)
- Stay calm.
- Gather the supplies I might need to treat this low. (In this case I gathered test strips, juice boxes, bunny gummies, glucose gel, glucagon, and regular syringes.)
- Try to determine why this severe low is occurring (for example exercise or illness) because it might determine treatment.
- Determine if there is active insulin which could continue to pull the blood sugar down.
- Think about my options and weigh what might have the best results. (In this case we gave a series of fast acting carbs followed by a protein snack.)
- Monitor blood sugar by finger stick in conjunction with CGM, if available.
I will say that we tend to rely on CGM for alerting us to highs and lows, hopefully before they get too high or too low. But sometimes with a rapidly changing blood sugar the CGM just can’t keep up. (Maybe this is why there is a disclaimer screen on the new pediatric version of Dexcom’s CGM receiver.) I never would have suspected that Q’s BG would have been 31 mg/dL as it was a pretty laid back night at home with no dance class or evening activity. Q felt her low. In fact she felt terrible. And she had the wherewithal to come tell me. It’s important, even for PWD’s using a CGM, to listen to how your body feels and to trust it.
Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.
All images are copyright D-Mom Blog and D-Mom Media and may not be copied or reproduced without express written permission.
Leave a Reply