Just another typical saturday. Sleep in until around 7-7:30 and get up for test, breakfast, and go run errands. Tori's morning number rang in at 272, which seems to be fairly common for her in the morning, and the Humalog dose was calculated at .75 units. Our syringes are marked in .5 unit increments so we can get fairly close by hitting in the middle of two marks. The NPH dose for morning is 5 units, and has been for several weeks now.
We ate a full breakfast, got dressed, and hit the road. We had to round up all the loose ends for Toby's birthday party later in the day, and were looking forward to all the excitement coming later in the day. Little did we know that excitement was going to come earlier than anticipated...
12:00 noon, I was getting ready to test Tori, and she was beginning to get a touch whiny (which really isn't unusual for her sometimes). She had just mentioned a few minutes ago while playing with Toby that her legs couldn't hold her up any more, and continued playing, so all seemed normal... until I looked down at the meter and read 28!!! Kristina quickly gave her a glucose tablet, and grabbed a juice box. We took turns holding her while she drank the juice, and kept her from falling asleep, while her eyes rolled and drooped, and she wanted to lay down. I could tell by the tone of Kristina's voice that she was a little bit scared, and I already knew I was on edge. At the moment I didn't care that she was upset with me for keeping her awake, there was no way I was letting her fall asleep. Fifteen minutes, and another test later she was back up to 104.
She has never been this low before, and she had shown absolutely no signs of being low, except maybe in hindsight we could take the comment about the legs as serious. I don't know how low she needs to go to go into a diabetic seizure, but I damn sure don't want to find out!
Fast forward to snack time, where she rang in low again with a 64. This time, given her lunch number I had decided to reduce the dinner insulin, so when it called for 1.74 I opted to go down to 1.5 to avoid any further lows. No dice...
I wondered after the fact whether or not I had given her the shot in an area that had not been thickened by insulin yet. For those of you that aren't aware, insulin injected or infused with a pump causes a condition called lipohypertrophy which causes the insulin to be absorbed more slowly than areas that haven't yet been thickened.
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5 comments:
When my 3 year old goes low, his biggest complaint is that his legs are weak.
This is the first time Tori ever commented about her legs. She doesn't seem to have any symptoms where she complains. I wish she did complain like your 3yo!
Scary - big hugs for you...I bet you'll never forget her sleepy look while she was going down.
I hope she's not showing signs of lipohypertrophy already. The doctor should be checking that at every visit and advising you to stay clear of those areas.
We hated NPH...it seemed to sneak up on Zack without warning - usually midmorning. His legs would look like they were giving out - walked like a drunk person. Are you using NPH in order to cut down on the number of shots per day? If not, do you want to choose other insulin therapy?
Yes, she's showing signs, possibly because we were first instructed to do the injections only in the upper thigh, and backs of the arms. We did arms in the morning, and thighs in the evening, switching between left and right sides of the body every day.
Now we do arms, stomach, upper thigh, outer thigh, and upper buttocks, but some hardened spots are already in place on the arms and thighs...
As far as NPH is concerned, we were offered the opportunity to go with Lantus and four shots a day, but daycare absolutely will not do shots, and we can neither one be guaranteed to be able to go do the shot at lunchtime, so we're stuck for now.
We are working towards pump therapy, and had hoped to start the ball rolling on our last visit to Riley's in Indy. The kicker was that her A1C went up from the previous visit, so the doctor wants us to get her under better control, and ironically, it's because of the difficulty in controlling her that we need to get on the pump...
I completely understand re the day care providers. Are they willing to give her a bolus with the pump if she gets a pump? The pump is not a panacea, but it can be a very useful tool.
You wrote "The kicker was that her A1C went up from the previous visit, so the doctor wants us to get her under better control, and ironically, it's because of the difficulty in controlling her that we need to get on the pump... "
What an awful argument against pump therapy for a 3 year old. You would be amazed at how differently each endocrinologist approaches insulin therapy. By the time our son was 7 we were on our 4th ped endo. Our 4th and still current endo encouraged us to put Z on a pump BECAUSE we couldn't get reasonable control on injections.
There are several studies now that point to the safety and efficacy of pump therapy in toddlers if you want background info to provide to the doctors. You can find the abstracts at pubmed by searching at this URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
Here's one of the newest.
: Diabetes Technol Ther. 2005 Dec;7(6):876-84. Related Articles, Links
Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia.
Jeha GS, Karaviti LP, Anderson B, Smith EO, Donaldson S, McGirk TS, Haymond MW.
Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Background: Hypoglycemia in preschool children limits the effectiveness of insulin therapy. Continuous subcutaneous insulin infusion (CSII) is not widely used in this group. Objectives: This study was designed (1) to test the hypothesis that compared with twice-daily insulin injection, CSII decreases the SD of the mean daily blood glucose (BG) and improves glycemic control and (2) to evaluate the effect of CSII on parental anxiety using the Parental Stress Index (PSI) scale. Methods: Ten subjects <6 years of age and receiving insulin injections were recruited. Each underwent two 72-h CGMS(R) (Medtronic Minimed, Northridge, CA) monitoring periods and then was started on CSII and re-monitored 3 and 6 months later. We assessed the effects of CSII on the mean BG and SD of BG values, A1c, PSI scores, and number, distribution, and duration of hypoglycemic episodes. Results: Pooled pre- and post-CSII data were compared. There was a 22% decrease in the BG variability (mean +/- SD 93 +/- 19 mg/dL vs. 72 +/- 5 mg/dL; P = 0.02) and a 13% decrease in A1c (8.6 +/- 0.8% vs. 7.5 +/- 0.7%; P = 0.01). There was a decrease in the 24-h median number and duration of hypoglycemic episodes [1.16 vs. 0 episodes/24 h (P = 0.01) and 1.19 vs. 0.05 h/24 h (P = 0.01), respectively], as well as the median number and duration of nighttime episodes [0.83 vs. 0 episode/night (P = 0.008) and 0.98 vs. 0 h/night (P = 0.008), respectively]. We found no statistically significant change in the PSI score. Conclusions: CSII in preschool children is feasible and safe. Pump therapy reduced the glycemic excursions and decreased hypoglycemia duration and frequency.
PMID: 16386093 [PubMed - in process]
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