# At what point is it a "severe" hypo?!



## Kei

F woke up at 1.2 this morning!    That's the lowest she has ever been, but she didn't even feel hypo.  Normally when she is at 3 or lower she feels shaky, wobbly and knows she is hypo.

We gave her glucose tablets and a digestive before her insulin, and her teacher is going to check her bloods at school this morning.  

At what point does your child normally go VERY hypo (enough to use the glucogel?).  We've never had to use the glucogel yet and hypos have, so far, been fairly rare for F, who tends to run high.


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## Freddie99

Hi Kei,

My own definition of a severe hypo is one that means I need help from others be it medical intervention or just my friends forcing me to eat surgary stuff or whatever. Personally I prefer to use glucogel alot of the time as opposed to tablets just because I find it's a bit easier to get down my neck quickly. 

I've just had a lovely 2.4 mmol/L and felt a little off so I tested and got that magic number. Toast and glucose in me so I should be better in a little.

Tom


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## Northerner

Hi Kei, I'd agree with Tom - it's bad if you can't deal with it yourself, although that's obviously very different when it is a child! 1.2 is very low, I think my lowest was 1.9 and I certainly knew it! If the reading didn't seem to correspond with how I was feeling I would be tempted to test again to make sure - the meters and test strips are reliable but aren't totally foolproof.

I think a lot depends on how quickly the levels are dropping - if very slowly, and particularly when sleeping, then your brain might be able to cope without distress but a quick drop would press the panic buttons. It's also possible that the 1.2 was the 'bottom' of the levels, and that it wouldn't have necessarily dropped any lower. I've occasionally had some hypos in the low 2.x's and not really felt any different, just happened to be testing before a meal.

I'm sure the other parents will be able to give you some better advice regarding children. Whatever the case, it's good that it doesn't happen often - hope it doesn't happen again for a long, long time


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## sofaraway

for me i've only had one severe hypo that need help from ambulance/ a&e, and that was more due to the fact that I hadn't realised I was hypo initially, my blood sugar was below 2 at the time but can't remember exactly what it was. My lowest has been 1.3 and I was able to test and treat, although a little scary was fine. 

I hope that you can find out what caused that hypo so that you can avoid it again. Might be worth testing in the night if you don't already to see what is happening. 

I wouldn't ever want glucogel as I find it tastes horrible, what situation would you think that you would be using glucogel for?


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## Adrienne

Kei said:


> F woke up at 1.2 this morning!    That's the lowest she has ever been, but she didn't even feel hypo.  Normally when she is at 3 or lower she feels shaky, wobbly and knows she is hypo.
> 
> We gave her glucose tablets and a digestive before her insulin, and her teacher is going to check her bloods at school this morning.
> 
> At what point does your child normally go VERY hypo (enough to use the glucogel?).  We've never had to use the glucogel yet and hypos have, so far, been fairly rare for F, who tends to run high.



Hi Kei

I think you may have the wrong idea about glucogel.   It can be used for any hypo.   Hell I've even used it when Jessica has been 5.0 before PE to give her a quick boost up although that is not strictly speaking what it is for.

My daughter for some strange reason loves glucogel.   However it does not work for her at all.   I have once given her three tubes on the trott and it has done nothing at all, really it hasn't so we can't use it anymore.   Have you actually tried it?    I know a couple of people it doesn't work for or doesn't work quickly enough for.

I'm sorry but I've forgotten how old your child is.   I'm a dingbat sometimes.   My own personal recommendation which loads of people also do, is start to get your child to like diet coke, seriously !   Again he may be already drinking it.    I started my daughter on diet coke at about 2 years old (she was diabetic by then).  You should have seen the looks people were giving me in MacDonalds but I knew that coke would one day save her life and believe me it has a couple of times.

Coke (full sugar) or lucozade are the best hypo remedies.    They are as good as putting a glucose drip in a vein.    If you stick to one of those (lucozade is better and quicker than coke but coke is damn fast) you will learn how much is needed to treat various levels of hypo.     For example start with 15 carbs worth which is 150 ml coke and 100 ml lucozade.    I know that for a hypo of about 3.5 Jessica only needs half the can of coke and only about 50 ml of lucozade.  (you can buy small party sized 150 ml cans of coke down the mixer aisles in supermarkets).

Glucogel is only 10 carbs per tube which may not be enough for a bad hypo and I would class a bad hypo as anything under 2.6 mmol.    In Gt Ormond Street Hospital, which in my book is the greatest hospital in the world for knowledge if a child is 2.6 or under the medical team run fast, I've seen it numerous times.    Different hospitals have different cut offs ie 2.2, 2.6, 2.5, 2.9  but GOSH say 2.6 and that is what I go with.

The idea is that brain damage can potentially occur with a blood level at 2.6 and under staying at that for an average of 4 hours.    Now that is an average number so there are cases when it has happened with levels higher than that and less time.    That is a reason why diabetics have 4.0 mmol and under as hypo.   

Glucometers are not brilliantly accurate down there either, so a reading of 3.0could actually be 2.5 or 3.5 !!!

You could try Glucotabs or dextrose tablets.   If your child has those give a glass of water with them it makes them work quicker.

I have loads of other tips but I may just drone on and on boring everyone so I'll quit while I'm ahead.

Bear in mind that I'm only a parent, like you, I don't have diabetes so what I say is all very clinical, if you like, and only from my experience over the years of seeing my daughter and loads of other kiddies.

Hope I have helped a bit.


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## allisonb

I agree with Adrienne.  Glucogel does absolutely nothing for me and tastes disgusting!  I've tried it a few times and my husband has given me it before when I've been too low to sort myself out and all it's ever done is go all over the place and stick my hair to my face!

I would go for lucozade every time, or coke if lucozade wasn't to hand and I'd consider a severe hypo as one that I needed help sorting or one that took a long time to sort because my BS was extremely low and still dropping.

Allison x


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## Copepod

*Glucogel tastes disgusting*

Once when both of us were semi-asleep, my partner tried to give me Glucogel (I think it was called Hypostop in those long ago days) - when I resisted, he tasted it, and agreeing that it tasted disgusting, unwrapped a couple of sweets I kept on the windowsill. he never tried again! I'd had a couple of tubes for years, but never used them, and then disposed of them when they went out of date and never got any more. Never discovered if Glucogel would raise my blood sugar...


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## Adrienne

I think that for a child severe is all hypos as they all need help with them.  Plus they can keep dropping while dithering around getting something.    

However I would obviously move faster for anything under 3.5 than a high 3 and even quicker for anything under 3.


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## delta

my son normally gets really bad moods the minute he's low
when he starts to answer me back and slams doors i say get ur meter
last night i asked him about five times to do a check he was starting to fall asleep so i di his check and he was 2.4 i think so three wine gums and within 5 mins back to his self again thats another grey hair for me then


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## Kei

Urgh!  I jinxed it!  Having said that she had never used the Glucogel, F has now used 3 tubes of it in the last 2 days, plus a tube of Hypofit, several packets of dextrose tablets, some flat lemonade and a few cartons of orange juice!

She got vomiting and diarrhoea on Wednesday night, so we've had two nights of checking/giving sugary stuff.  She's starting to eat properly again now, thank goodness and seems to be getting better.

Thank you for all your replies!  I think our DSN had probably suggested only using the Glucogel for very severe hypos because of the bad taste.  I'd never have got her to use it normally, but when she was half-asleep in the night and her reading was 2.2, it was the only thing I could get into her.  She pulled some hideous faces though!!!!


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## Adrienne

Wow what a few days.  I hope she is on the mend.   I use coke at night with a straw poked in Jessica's mouth and she drinks it and doesn't even wake up. 

Just one thing lots of people I know have decided that fizzy is better than flat lemonade or coke.  Something about the bubbles that makes it work quicker.


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## Kei

Adrienne said:


> Just one thing lots of people I know have decided that fizzy is better than flat lemonade or coke.  Something about the bubbles that makes it work quicker.



F hates fizzy drinks!  I normally use orange juice if she's hypo, but with diarrhoea I didn't think orange juice was a great idea!


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## Adrienne

Kei said:


> F hates fizzy drinks!  I normally use orange juice if she's hypo, but with diarrhoea I didn't think orange juice was a great idea!



Hee hee yep you are right about the orange juice then.   Lots of kids don't like fizzy drinks.   I guess because Jessica has always been diabetes since 5 weeks old then I knew that coke or lucozade would be needed so I started her from a young age on diet coke.   I tell you the looks I had but stuff it.   It worked.

One friend has a real problem treating hypos.  Her young daughter will only have those pre packed tubs of peaches in syrup so she has to use that.  Basically you use what you can get in as quickly as possible.


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## ruthelliot

Hi,
My little boy is now 2and 1/2 and has been diagnosed for a year. He has been totally unresponsive though still able to swallow at 2.4 - this came on him very suddenly and the only thing i could get into him was glucogel so now i never go anywhere without it. I have tasted it and its pretty vile but he doesn't seem to object. He has also been quite low in the mornings with little signs so i think it does make a big difference how quickly it comes on - his worst hypos have always been out of nowhere during the day. 
Last night I checked him at around midnight and he was 5.9 - this is never enough to see him to morning so i gave him a 5g biscuit expecting him to be around 8-9 in the morning but he was 15.4?? Does anyone have any thoughts - could this mean he has hypo'd and had an overswing? He has been a bit allover the place lately and nothing seems to be making much sense.


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## Adrienne

ruthelliot said:


> Hi,
> My little boy is now 2and 1/2 and has been diagnosed for a year. He has been totally unresponsive though still able to swallow at 2.4 - this came on him very suddenly and the only thing i could get into him was glucogel so now i never go anywhere without it. I have tasted it and its pretty vile but he doesn't seem to object. He has also been quite low in the mornings with little signs so i think it does make a big difference how quickly it comes on - his worst hypos have always been out of nowhere during the day.
> Last night I checked him at around midnight and he was 5.9 - this is never enough to see him to morning so i gave him a 5g biscuit expecting him to be around 8-9 in the morning but he was 15.4?? Does anyone have any thoughts - could this mean he has hypo'd and had an overswing? He has been a bit allover the place lately and nothing seems to be making much sense.



Hiya

You could be right.  He may well have hypoed and this could be the natural rebound along with a bit of dawn phenomenen as well.   Did he do anything a bit more energetic within the 36 hour period before hand, even mentally more demanding.    

Unfortunately diabetes in really young ones is so hard.

Have you tried him with diet coke.   I know it goes against the grain, but it would be a really good idea to start him getting used the fizzy drinks now, even a sip at a time.   You can get 7Up Free or Orangina light,  and slip in the odd diet coke.   It will be so much quicker to get him up from hypos with full sugar coke or Lucozade when he is a little older.    Don't get me wrong it would be easier now but unless your son is highly unusual it is very rare that little ones like these fizzy drinks which is why its good to get them used to it now.

Do you test him overnight?   What regime is he on?   Most children do not wake up when hypo at night.   Lots of DSN's will tell you no need to test overnight but my reasoning is that unless they can 100% guarantee me that my daughter will be safe overnight then I test.    Between 2 and 3 am is a good time to test.   If you are unsure of what is going on then spend a week testing.     I knew that if my daughter was 10.0 at midnight I didn't need to test at 2 am so long as she had not done any extra activity during the day.  If she was under 10.0 I always got up.


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## delta

ruthelliot said:


> Hi,
> My little boy is now 2and 1/2 and has been diagnosed for a year. He has been totally unresponsive though still able to swallow at 2.4 - this came on him very suddenly and the only thing i could get into him was glucogel so now i never go anywhere without it. I have tasted it and its pretty vile but he doesn't seem to object. He has also been quite low in the mornings with little signs so i think it does make a big difference how quickly it comes on - his worst hypos have always been out of nowhere during the day.
> Last night I checked him at around midnight and he was 5.9 - this is never enough to see him to morning so i gave him a 5g biscuit expecting him to be around 8-9 in the morning but he was 15.4?? Does anyone have any thoughts - could this mean he has hypo'd and had an overswing? He has been a bit allover the place lately and nothing seems to be making much sense.



does sound like hes gone low and come back up again what was he before bed
if my son was 5.9 before bed would need at least 10g of carbs or maybe a bit more


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## SacredHeart

Adrienne - re flat vs fizzy drinks. I think you're right. It's the fact it's carbonated. That would make sense, since things like champagne (obviously extremely carbonated) get you drunk faster. Don't hold me to this though, since I haven't researched it or anything!


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## Patricia

ruthelliot said:


> Hi,
> My little boy is now 2and 1/2 and has been diagnosed for a year. He has been totally unresponsive though still able to swallow at 2.4 - this came on him very suddenly and the only thing i could get into him was glucogel so now i never go anywhere without it. I have tasted it and its pretty vile but he doesn't seem to object. He has also been quite low in the mornings with little signs so i think it does make a big difference how quickly it comes on - his worst hypos have always been out of nowhere during the day.
> Last night I checked him at around midnight and he was 5.9 - this is never enough to see him to morning so i gave him a 5g biscuit expecting him to be around 8-9 in the morning but he was 15.4?? Does anyone have any thoughts - could this mean he has hypo'd and had an overswing? He has been a bit allover the place lately and nothing seems to be making much sense.



Hi there

Just joining in here -- agree with everything Adrienne has to say, though as yet we have been unable to get our son to do fizzy drinks...he's older, and has never liked them. He has also been diagnosed about a year.

One thing about biscuits though: this may seem silly, but we have had several occasions of a very small biscuit at night (8g) seeming to cause a weird high number in the morning....Like your experience, this is from 6mmols or so at bedtime. We are so convinced that some biscuits -- McVitties choc digestive, to be exact! -- cause this, that we no longer buy or use them for free carb. Other biscuits seem fine for this use.

re rebounding from night hypo: while anecdotally this seems to happen, it has not been demonstrated in test conditions. It makes sense in theory the body would catch itself in the event of a real crash, kick out glucose, then everything would rise -- but a) if it happens, it would seem to happen very rarely (eg if it's a pattern, it's not rebound) and b) like everyone says, we can't depend on the body doing this if there's a hypo at night. Certainly in our experience if there is a high waking number, rebound will be one of the things consultants want tested (eg a 3am test), but it is thought to be unlikely in the larger scheme of things -- CGMs have not been able to demonstrate it, though anecdotally people feel it's happened. It would have to happen though in the case of a severe low -- and the person would likely feel really quite rough the next day? 

If it's not the biscuits (which I agree it shouldn't really be!), then dawn phenomenon and/or a spluttering pancreas may be the culprits...

Diabetes. Nightmare.


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## ruthelliot

thanks for the input guys,
last few nights have been a bit more stable. Adrienne he's on twice daily levemir and 3-4 times daily novorapide. someone suggested giving him his night time levemir earlier so it peaks during the night but he's i fear whatever we do it solves one problem and creates another! Feeling particularly disheartened as we've been waiting for the last 3 months for referral to another hospital to start insulin pump therapy and having initially been told he was a great candidate and totally qualified the other hospital, who we do still fall into the catchment area, is refusing to accept the referral and wont even consider putting him on a waiting list for a pump as they have enough of their own patients on the list!! I know a pump isn't all rosy but with his increasingly erratic results combined with a growing aversion to injections I really hoped things could be better. Seems not.


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## ruthelliot

ruthelliot said:


> thanks for the input guys,
> last few nights have been a bit more stable. Adrienne he's on twice daily levemir and 3-4 times daily novorapide. someone suggested giving him his night time levemir earlier so it peaks during the night but he's i fear whatever we do it solves one problem and creates another! Feeling particularly disheartened as we've been waiting for the last 3 months for referral to another hospital to start insulin pump therapy and having initially been told he was a great candidate and totally qualified the other hospital, who we do still fall into the catchment area, is refusing to accept the referral and wont even consider putting him on a waiting list for a pump as they have enough of their own patients on the list!! I know a pump isn't all rosy but with his increasingly erratic results combined with a growing aversion to injections I really hoped things could be better. Seems not.



Also can I ask what would you say was a good hba1c result for young kids - anyone any idea, and whats too high??


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## bex123

as i have been type 1 since i was a child i had a lot of hypos , my mum reported to me that my 'passing out point ' was 1.3 , as an adult i tend to have more problems with the hi's now although i have collapsed on a couple of occasions from the low's, i normally gulp down a whole tube of gluca gel if im about 1.4 ish as i know if i dont boom i will be out like a light..anything above 2.0 a bit of lucozade and a couple of buiscits gets me going again


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## Moddey

ruthelliot said:


> Also can I ask what would you say was a good hba1c result for young kids - anyone any idea, and whats too high??


We were told that 7-9 is good for hba1c. But the nurse also said it is very individual and depends on the stage of the diabetes (we got told that two mths after diagnosis) and the age of the child.


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## Adrienne

Moddey said:


> We were told that 7-9 is good for hba1c. But the nurse also said it is very individual and depends on the stage of the diabetes (we got told that two mths after diagnosis) and the age of the child.



Hi Ira

I'm so sorry but this is not quite right, you have been given duff information by your nurse and its quite dangerous advice as well.

Any HbA1c over 7.5 is considered too high.   When you hit the 8 and 9's it is far too high.

It is so very very hard to get good control and get good HbA1cs that lots of docs and nurses say 8's are ok.  They are not.    There is a study been done recently that continued results of over 7.5 (this includes readings of 7.6 and above) can mean there could be some problems later in life.

However saying that, the HbA1c is not the only way to measure if control is good.    You could have an HbA1c of 6.9 but due to too many hypos or swings.    If you have a result of under 7.5 and you know it is because of definitely good overall readings then that is great.

We did manage to get my daughter's down to 7.3% when she had been pumping for a year.    It shot up when we had a very bad period a couple of years ago and I have been fighting so hard to get her down again to good control.    The last result I had last month was a real breakthrough for me and we hit 7.8 % .    I strive for that 7.0 or 6.9 but with good results to achieve that and not hypos.

If your child's HbA1c is able 7.5 then your team should be working with you to get it lower.   

Please please please don't accept that anything over 8 is an ok reading, it isn't and never will be.  Your nurse is wrong.   

However just a quickie, if your child's HbA1c is over 8.0, please don't beat yourself up about it, things just need tweaking to bring it down.   It is not your fault, this diabetes lark is damned hard work for parents (and others of course).


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## Patricia

Yes, agree with all! We were told similar early information, but have since learned all Adrienne says.

Saying all that, it is SO hard, especially with growing children. You've got to just press on, but not beat yourself up, if it doesn't feel 'good enough'. It's a marathon type thing, not a sprint...

Most teens struggle hugely with keeping a decent HbA1c. We are doing well so far, but certainly one of our good ones was down to FAR too many hypos. The swings also do their damage, as Adrienne says. So what you are after is a kind of evenness of readings...

We find this impossible at the moment. I'm not sure when it will improve, but we have been chasing and chasing for weeks now: too high, too low, precious few in range. Suspect again that the HbA1c will be fine -- but the swings have been too many. We can but try. Teenagers and hormones wreak such havoc...


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## Kei

F felt "slightly wobbly" earlier and turned out to be 1.3.  Sometimes she can feel very wobbly indeed and be 5.5...  It's so difficult to tell sometimes.  Thank heaven for monitors!


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## Adrienne

Gosh that's a low one, hope she is ok now.


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## grahams mum

graham lowest has been 1.3  and the last 6 months average is gone up to 9.5  ill try my best but been so active and the school is difficult is not like reading from a book  the consultant they should really have their children with diabetes  and maybe they will understand is not so easy


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## Patricia

We have also had the same scary thing - E's lowest numbers have seemed to have few of the usual signs..... We and he now think this may be because they come on slowly.... V scary!


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## ruthelliot

At the risk of showing my ignorance can someone tell me what the dawn phenomenon is - is this to do with increased growth hormone during the night?? Also Adrienne did you manage to get your daughters hba1c that low even when she was younger (a toddler). Ben's last one was 8.4 and we were told we should be really quite happy about this.


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## Adrienne

Hiya

I can never remember what the dawn phenomenen is but I do know that everyone can have it, even non diabetics but with people with diabetes it can have a greater effect.   The blood sugars rise quite a bit at dawn so they wake up higher than you think they should.

The Hba1c is a hard one to comment on.   When Jessica was Ben's age there wasn't even Lantus or Levemir around.   There were only mixes of different makes and kinds.   I don't ever expect anyone on mixes to get a great HbA1c, in my opinion mixes need chucking out totally.   In Europe they are not used.   All newly diagnosed children and adults are either on a pump of MDI (Lantus or Levemir and novorapid or equivalent).    Mixes in this country are used for money purposes and I've heard DSN's and consultants say 'it is easier for the school'.  That just makes me feel sick and those people need shooting at dawn.

If Ben is on mixes then yep I would be happy with 8.4%.  However if he is on mixes then whilst he is young enough, get him changed as quick as you can to MDI.  Yes it is more injections but you will be getting greater control which has a huge impact on his health and life in later years.   What you do now affects him later.    Sorry if this is sounding harsh and if you know all this then ignore me.  I hear parents saying they don't want to inject their child more than twice or that their child wouldn't like it, well my answer to that is that their does their child want their eyesight in 15 odd years etc etc you get the drift. 

If Ben is on MDI then you can potentially get the HbA1c down a lot lower than that.   Your team should have taught your carb counting and what ratios to start at and then help you tweak them.   Most people need more insulin at breakfast than tea time.   

If by doing all of that you can't get the HbA1c down then the pump is the next thing.    

Ad Ben is under 12, if he is on mixes you can skip the MDI stage and go straight to a pump which is hard work but the next best thing to a working pancreas.

Do not always go with the A1c.    Ben's is 8.4 which clearly shows he is too high most of the time.   However on the other end of the scale if you have a result of say 6.5% that could be because you are having lots of hypos and swings so you cannot always see that.

I think in this country some teams are way behind on care whilst 5 years ago  8.4 as ok on mixes, for long term  health it isn't at all.    It is early years where you can help to make it a lot better for them in later life.     I know you didn't sign up to diabetes when you had Ben, like I never signed up to any of this either but unfortunately for our kids they have it but fortunately for them they have us and we can do great things for them.

Sorry I seem to have gone off on one but I just want to help people.   I hope that helps with the A1c.

If you want help with anything I'm happy to help.


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## ruthelliot

Yeah adrienne Ben's on levemir - origonally twice daily but we dropped to once daily about 3wks ago (though our consultant didn't recommend this) and novorapide at meals. His last hba1c was despite a lot of hypos and as we have tweaked things and are now getting slightly less I fear the next one may be higher. We're currently waiting to see if we are getting referred to a different hospital as i'm really unhappy with the advice we're getting just now (I would rather see a paediatric endocrinologist rather than a general paediatrician who once did a few months in endocrinology!). They've had us carb counting from early on though all other dietary advice has been pretty crap. His ratios seem to change on a daily basis just now and every day we're either getting highs or lows. Been having real problems with midmorning highs (often over 20 , 2 and a half hours after novo) then crashing at lunchtime - have got on top of this to some extent by sticking to one type of cereal cutting out his night time levemir and increasing the morning ratio but he's getting pretty scunnered with shreddies!!  My biggest problem is not knowing how good I should hope to get things - I know I am a bit of a perfectionist but I'm sure things could be better. We've been told he "needs the mid morning high" but the thought of him running that high for up to 3hrs every day worries me (and makes for a lot of toilet stops!!) Sorry for the rant - just feeling a bit lost and dissillusioned just now. All advice gratefully received.


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## Adrienne

Don't get down, please, we are all here to help. 

Lets start with this mid morning high, to put your mind at ease a bit.   Unfortunately this is the same for most.  A mid morning spike is horrendous.   However there are ways and means of bringing it down again for most.   I never could, it was impossible but now we are pumping, it is so much better.

When do you inject the Levemir, morning or night.   This can make a big difference.   You will find it only works between 16 to 18 hours, so if you are injecting in the morning and he is waking high this is most probably not be the dawn phenonenom but will be the Levemir running out.   The only way to stop this is to inject at night but then you may run the risk of hypos overnight as the levemir works best in the first half of its life normally.   This is why most people do split the levemir into two injections.     If you are unhappy with this, then ask to change to Lantus.   Same sort of thing but different company.   It does last longer, anywhere between 18 and 22 hours so you could inject in the morning and he should be ok the next morning.   We used Lantus.

To combat the mid morning spike and then the huge crashing by lunchtime which come as a pair unfortunately you can try things.    The first is to inject the NR about 20 to 15 minutes before he eats breakfast.   The NR needs to work before the food starts working.    This may help with the spike.   I imagine he is waking up high which is helping the spike be much higher.  There is already insulin resistence in the morning and waking high will not help at all and you will get the inevitable spike unless you give him an extra shot of NR when he wakes up as well as his breakie shot, which i know you won't want to do and I don't blame you.

On MDI quick food is good, goes against the grain totally but for breakfast you should have some quicker acting carbs than weetabix etc.  You should experiment.   I know lots of kids have those chocolate wheetos !!   Try coco pops, seriously.    What should happen is he will go up quickly ie within an hour, and then drop back down again at the two hour mark.    This is where snacks for people of MDI come into their own.    He will definitely need a proper snack at that 2 hour mark if he is to make lunchtime without a hypo.   We used to have to give 15 grams of carbs as a snack, absolutely no fruit at this snack time (unless it is an extra on top of the proper snack).   We used Harvest Chewee bars and still do sometimes.   Some people find 20 grams is needed.    This should have some fat in it, ie biscuits that add up to 15 or 20 carbs, snack bars, toast even but not white !    This snack is sooooo important and will get him to lunch time.

I could go on and on and on but I'll stop for the moment.   I hope this has been helpful and its clear enough.    Please let me know if I can help.  Please don't get down, you really are not alone.


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## ruthelliot

Thanks Adrienne - will continue to muddle on! almost had a day of perfect results today until we got a 3.1 at bed time - Aaaaargh! Maybe tomorrow. I remember my dsn and consultant telling me the week Ben was diagnosed how in a years time it would just be a part of everyday life and we'd hardly give it a thought - seriously? Is that ever the case coz seems like it's what I think about most of the time. Ah well I'm working on perfecting my poker face for his next appointment so I can just smile sweetly and get out before I bite their heads off.


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## Patricia

I have had literally COUNTLESS medical professionals (including some family) tell me/us that within a year it will be 'second nature'. It always makes me want to shoot them.

And shows their ignorance, or unwillingness to look and see. 

It gets easier, I'm sure. But I'm not convinced that it ever gets easier than it is now for us. My son was diagnosed the same month and year as yours! The pump has been life-changing, etc... But second nature?! No way.


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