Thursday, February 3, 2011

My Kid Can't Feel Her Lows

Hypoglycemic Unawareness has Plagued our family since Rowan's initial Diagnosis. She was 18 months when she was introduced to Mr D, and she is now 6.  Unfortunately she still has no awareness when she is low.
"This is what the symptoms are when you are aware"

So, being the inquisitive person I am, I did a brief search of the literature, actually more like an extensive search.  My response from Team Diabetes was basically she has an immature nervous system and will eventually feel them(the low blood glucose) Well we are still waiting... 

I found a few research papers today that discuss the impaired regulatory response that children with type 1 diabetes can exhibit when hypoglycemia occurs.

First one is a study published in Diabetes Care in  2009 titled, "Impaired Awareness of Hypoglycemia in a Population Based Sample of Children and Adolescents with Type One Diabetes".  The researchers sent out a questionnaire to 656 patients to determine hypoglycemia awareness status.  Out of the 656 respondents, 29 % had a decreased level of hypoglycemic awareness.  The 29% also had an earlier onset of diabetes.  Hmmmm, this is starting to make sense to me now. Earlier onset, less awareness.  They further stated that the tighter the control the more hypos that occur, and also the lower the A1C the more unawareness.  The more hypos a child has the more unawareness exists.  Great! What do I do now?

So I kept searching...

The second study I read was also published in Diabetes Care  in 2009 titled, "Blunted Counterregulatory Hormone Responses to Hypoglycemia in Young Children and Adolescents With Well-Controlled Type 1 Diabetes" Sounds just as discouraging!  This study took 14 kids (3-18 yrs with 3 kids less then 8) Put them in a controlled in-patient setting on insulin pump therapy to induce a progressive drop in blood glucose in order to measure the counter regulatory response to low blood glucose levels. Interesting! So what did they discover? They found that four young children and 4 adolescent children never had an epinephrine response with a glucose < 4 mmol. Those that had an epinephrine response, it didn't occur until the blood glucose level dropped below 3.3 mmol (for US multiply the mmol value by 18) Scary, but information is, what it is. 

It answered my question; why my kid doesn't feel her lows.  When she drops and doesn't wake,  it is because her body's "Flight or Fight" system doesn't kick in, and no adrenaline is released. In other words;  no sweating, or automatic wake up "jolt" out of bed.  The scary thing for us is, does this ever subside, or will it go away as she gets older. That, I guess will be my next research question.
Will my little girl ever feel her lows?

Trev

If you have any information or feedback regarding Hypoglycemic unawareness please comment, I appreciate all feedback.  Thank-you.

DIABETES RESEARCH IN CHILDREN, NETWORK (DIRECNET) STUDY GROUP*(2009). Impaired Awareness of Hypoglycemia in a Population Based Sample of Children and Adolescents with Type One Diabetes.  Diabetes Care 32: 1954-1959.



TRANG T. LY, MBBS, PATRICIA H. GALLEGO, MD, MSC, ELIZABETH A. DAVIS, FRACP, TIMOTHY W. JONES, FRACP, MD
(2009). Blunted Counterregulatory Hormone Responses to Hypoglycemia in Young Children and Adolescents With Well-Controlled Type 1 Diabetes. Diabetes Care 32: 1802-1806

3 comments:

Celine said...

I knew someone who stopped feeling their lows after years of diabetes. Their doctor told them to keep their blood glucose levels high for a few weeks and then bring them back down to normal range. Apparently that was enough for them to start feeling lows again.

Reyna said...

Joe sounds like Rowan...he has been feeling his lows now...during the day. He catches them when they are in the 60s. He used to go into the 30s and 40s without catching them when he was 3,4,5 years old. He hasn't been in the 30s for a long time, but I used to catch him sleeping in the 30s - it scared the bejeezus outta me.

Great post Trev.

Jody said...

My daughter is 7 and is also unaware of her lows. I remember the day it clicked for me that her response was not typical. We tested and she was 39. Her response was, "test me again, that can't be right". She showed no physical signs of a low and I'm a pro at recognizing them (my husband and mom are T1). Super scary! We immediately started the process to obtain a Continuous Glucose Monitor. It has changed her life and ours. It gives her knowledge and control of her BG during the day and allows for easy checks at night. She doesn't wake with lows at night like my husband does - I think that is typical - but I can hear her alarm from my room. I've caught many lows that way. It is expensive and worth every penny.