Low, Lower and Lowest

"Last Evening"

One word to describe life at the moment.  Actually three words. But once again, diabetes, in all its power, has this sneaky way of ripping the proverbial rug from under you.

On my way to bed last night, a little later then usual, as I was into a really good book, I did the "Security check" to ensure Rowan's sugar was at a safe level for the night.

5, 4, 3, 2, 1......beep, and 2.0 mmol/L  or 36 in US terms. 

WTF !

The juice on the table beside her bed was empty, and not replenished, Shit!!!

I leaped down the stairs, retrieved a juice box, and leaped back up to her bedside. She was alert, and drank the juice, gulping it down, with her eyes closed and the sweat soaked through her PJ's.  I guided her gently back down, and just sat there. In the dark, cursing this (*&^*%^ disease. In my head of course.

I strolled down stairs super slow, feeling defeated once again. Going through the evening's events, in an attempt to account for this curve ball that was sprung on us violently out of the blue. And, nothing popped out as an obvious cause. Great I said to myself. Not even able to develop any preventative plan to avoid this attack in the future.

I think this is the most draining and difficult thing about diabetes, the unpredictable events that can't be prevented or planned for.  Those unexplained anomalies. Our only weapon is glucose monitoring, trending, proper food to insulin to activity amounts........Ya good luck with that with kids and diabetes who are bar none the most unpredictable creatures on the planet.

Mr Diabetes, this was really low of you, one the lowest for Rowan, and you remind me to never trust you and lower our guard. EVER.

Trev

Why Worry if You Feel Great?

I jotted this title down months ago, in a little detective note pad I carry around everywhere, I know, a little geeky, but what can I say.

I was reminiscing about the early days of diabetes, well early is subjective, but for me it was when you were given one shot a day and they measured control with urine dip sticks and your ability to gain weight.  Scary, but I survived, and so did many others. Imagine dipsticks for control, crazy!

"Those were the days"

I didn't feel all that bad on one shot a day, and actually started to feel worse when my control tightened and was consistently near normal range.  The body is amazing, it got used to the high levels, and that was that, it equalized, so to speak. 

When the levels normalized, the body said "What the hell is going on!" and sent the signal to produce the good old epinephrine (fight or flight Response) and wham, you start feeling like crap with your good numbers. 

For some, including me, it  was discouraging not knowing that the feeling would subside in time.  Why torture my self, why shoot for normal levels when I feel shaky, and low all the time. That's where knowledge is power, and motivating!  It took one Diabetic Educator in 1990 to say, "you know it is only temporary, and then you will feel great!"  One moment, one snippet, is all it took! 

I get the above scenario a lot from patients and those with higher A1C's.  They say " I feel fine, why should I change anything" or "Well,  I took the night time insulin and my fasting is 5 mmol,  but boy I feel like crap" or they claim, that their normal is actually 10mmol (multiply by 18 for U.S.) The point is, they don't feel the need to change if they feel good. Of course I jump at the opportunity to share my snippet, in hopes to motivate them to keep there levels down just long enough to feel fab! 

Most folks have never been told the reason behind feeling worse with better numbers.  I am fortunate to be in a position to explain these pearls of experience with folks trying to better manage their diabetes control.  I hope anyone going through diabetes and feeling "great" and not worrying will take the snippet for themselves or a loved one, and shoot for those normal targets!

I did find one research article written by Gill Spyer and colleagues titled,  "Hypoglycemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes."  They took 7 type 2 diabetics with a mean A1C of 7.4%, and tightened their control.  This is what they found:

"Symptom response took place at higher whole-blood glucose concentrations in diabetic patients than in controls"  and they also commented "This effect might protect type-2 diabetic patients against episodes of profound hypoglycemia and make the achievement of normoglycaemia more challenging in clinical practice."
Most of my experiecne is purely anecdotal.  But this study certainly supports the theory.

Have you ever Been High for a period and dropped low?
If so please share your comments. 

Trev

Sources:
G Spyer MRCP, Prof A T Hattersley FRCP, K M MacLeod MD, (2000) Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes,
Lancet. 356(9246):1970-1974.

It's Never Good To Be Unaware

To be unaware, in general,  is usually not a good thing but with Diabetes it can be out right life threatening.

Hypoglycemic unawareness is a frightening reality for some of us with Diabetes.

It is usually a complication brought on by long term damage to the nervous system from many years of diabetes, usually poorly controlled diabetes. 

I say usually because I have discovered it can also happen in children diagnosed with type 1 diabetes that are under the typical onset age of 7-9.  

We have a daughter who was Dx at 18 months, she is now 6.  She has never been able to tell us or recognize when she is having a low glucose.  

In the beginning this was expected, but now we are hoping even praying that soon she will show some insight when she is hypoglycemic.

We have searched for answers, especially in the beginning.  The explanations from the literature and the health team was that her nervous system was immature and in time she would eventually feel and display the signs (sweating, shaking, mood change) and symptoms (anxious, headache) 

We're still waiting.....

In the mean time we do what is essential to keep her safe. We advocated for a pump, we test multiple times, and we lose a lot of sleep.  

So, if you have a child with Hypoglycemic unawareness, we understand. Here are some suggestions below.

Treatment options are: 

-Peak-less insulin

-Continuous Glucose Sensors(these are expensive and the needle is huge!) 

-Insulin Pump therapy

-Frequent testing to ensure glucose is safe throughout the night. 

-Ensure the last rapid insulin bolus is no later then 8 PM.

So, if you have a child with Hypoglycemic Unawareness, we understand, hang in there, and unfortunately it's up to us to have the awareness, perseverance and diligence until our child's system develops.

Trev

Insulin Pumping for Toddlers–Rowan’s Story

As I mentioned in my profile and previous blog I have 2 children with Type 1 diabetes.
Here she is:

Rowan was diagnosed when she was 20 months.  She exhibited the typical signs of onset like; unquenchable thirst, frequent urination, increasing irritability, and she generally looked unwell. 

We decided to use my meter to confirm what we suspected---and her blood glucose reading was 32mmol.  We were emotionally shocked----yet intellectually aware of what was going on.  My personal thoughts were “my damn genes are responsible for this”

We proceeded to the hospital to confirm the diagnosis of diabetes.  They re-hydrated her little body with intravenous fluid, sent off some blood work, gave a dose of rapid acting insulin, and referred her to the Pediatric Clinic the following morning. 

This forever changed her little life and also ours.  When you have a child with insulin dependent diabetes you really never truly sleep (especially the moms) or stop worrying.

The following morning we went through the standard curriculum for pediatric diabetes; diet, insulin injection teaching, targets, and hypoglycemia/hyperglycemia management.  We met the Social Worker, Nurse Educator, Pediatric Endocrinologist, and Dietician.

My wife and I were still experiencing the shock, so needless to say we didn’t retain nearly as much as we would have liked.  Nevertheless we did attend subsequent follow-up visits and did a lot of our own research on type 1 diabetes and children. 

Rowan was absolutely amazing! She took everything in stride.  It was three long days to us adults, but to a little child it probably felt like an eternity. There were two other families present during the education sessions.  Both were older children more typical for the onset of diabetes.  Rowan was so tiny, so innocent, and so brave.

What changed in our life?

Mental Health:  We were very overwhelmed in the beginning and really did not have time to deal with the emotions that we were feeling.  This subsided with time, increased knowledge, and new habits.  This aspect should always be addressed and is often not.

Food:  everything had to be measured with precision (we were told a small amount of error has a huge impact on her blood glucose) in order to avoid wide swings in glucose levels.

Insulin:  she did not like needles (go figure) every injection was met with resistance (Let the chase begin) Rowan didn’t know why we suddenly had to “poke” her 2-3 times daily. It broke our hearts.   

Blood testing:  Rowan didn’t mind the finger tests. Thank the lord.

Challenges:  

Toddlers are the most unpredictable eaters, so even though we’d carefully measure her meal and give her injection pre-meal we struggled with her to eat all her food, and this often resulted in last minute substitutions---usually less desirable choices.

Hypoglycemia is the “thorn” for us, and based on our own research and self discovery children under the typical onset age of 7-9 often do not feel the symptoms of hypoglycemia (The neurological system is too immature) Rowan is now 6 and is just beginning to recognize when she feels “low”

What did this mean for us?  Well a lot of sleepless nights and a complete change in her insulin regime. 

We struggled for months with her insulin regime.  There were nights she would drop low and other times where she would maintain normal readings.  There was no obvious pattern despite having the same routine and insulin/food amounts.  Very discouraging….

Then came the pump---and this greatly improved our quality of life!  The pump provided Rowan with continuous amounts of insulin 24 hours a day and required a “poke” or plastic catheter needle to be inserted every 3 days.  It provided us with the ability to safely give smaller doses of insulin to more closely match her requirements. It has also been proven to lower the risk of night time lows---which we can contest to.  

In summary: 

-Deal with the emotions----or they will deal with you.

-Learn all you can about your particular type or your child’s type of diabetes

-Consider the best therapy (insulin pump, pills, combination) for your diabetes. 

-In the beginning it may seem insurmountable but with time, effort, understanding, trial       and error, you will manage to effectively cope with diabetes. 

-Do not blame yourself if the numbers aren’t normal----simply ask “why, and what”

Why is the reading low?  To active, to much insulin, didn’t finish eating….

What caused the off reading?   Sick, stressed, forgot to bolus….

Most often you can attribute it to something and learn from it. 

Day-to-day life with diabetes is a challenge, and that’s how I view it, a challenge, something to beat, or manage successfully to avoid long term complications.

Yours in Health,

Trev