Help please?

[Janaka81]

Hi, my son was diagnosed wit type 1 3 weeks ago, and so we're quite new to this. Things were going ok although we are still adjusting his Levemir at night as it's too high and he keeps having hypos at night. He's been a bit poorly the last couple of days mainly due to teething I think. He's had a temperature although he's fine today but he does not want to eat anything! We were up with him most of last night to treat hypos and make him eat something but it was a struggle even get sweets or glucojus into him as he's no apetite and just wanted to slee. He's up again now and I've treated his hypo, but I can't get anything into him - I've tried biscuits, fruit, toast, sandwich, breadstick, cereal, weetabix... Anyone have any brainwaves as to what to give him to bulk up his bloodsugar for the night? Would I be a really bad parent by offering him a fruit lolly, and would it be sufficient?! I feel so lost...

 

[Northerner]

Any form of carbs you can get him to accept would be good, so a fruit lolly would be fine - try and find out the carbs in it. Also, will he take fruit juice or a full sugar drink? These are what I existed on when I was struggling with illness recently. Have you reduced his insulin? Are you in contact with his DSN? He/she should be able to advise on the adjustments needed.

 

[Copepod]

Welcome to the forum, Janaka81.

As he's teething, he must be very young. Will he eat pouches of fruit puree intended as weaning food? I use these as a source of sugar / carbohydrate when running or occasionally with low blood sugar at night. You'll need to read nutritional info carefully to get highest CHO content. Generally banana is a key ingredient for this.

 

[Hanmillmum]

Hi Janaka and welcome 🙂

Sorry to hear your son is struggling with hypos, hopefully as you continue to reduce the levemir with his team these will settle down nicely.
We have had problems dealing with night hypos too and getting my daughter to try to eat or drink something sufficient enough to get the blood sugars to a decent number. She will fight it sometimes. The best approach I have found it to use something very concentrated in sugar so it means less effort for her - she will suck on the glucogel individual tubes when she is half asleep, which is good as most then by-passes her teeth 😱 we get these on prescription. Alternatively if we are out of stock I will fill a medicine syringe with golden syrup and she will suck on that. Not great or nutritional but the most important thing is to treat the hypo. You can get the nutrition they need through the day when the child is more amenable

These days it's not too often needed but I did mention to the dentist what we sometimes have to do in the night as she had no idea and we were recommended a slightly higher fluoride toothpaste and my daughter had her teeth coated to protect the enamel.

Any way I hope you find a solution, it's not easy!!

 

[Copepod]

Just a word of caution about fluoride in toothpaste - dose depends on whether you live in an area with fluoridated tap water (and drink it, of course), plus young children should not use mpore than a pea sized blob and should not swallow toothpaste (or not all of it, to be realistic!), otherwise they run the risk of getting brown discolouration, which will remain for life on adult teeth - admittedly, if Janaka's son is teething, they are not getting adult teeth yet.

Need for hypo treatment will decrease as you get the Levemir long acting dose right. However, stress eg teething, and infections, can both increase need for Levemir, so dose may need to be decreased when teething ends. Plus dose usually needs to increase as child grows. That's why your DSN needs to be available to help you adjust the doses.

 

[Janaka81]

Hi. Sorry I haven't been in here since I wrote the message, but thank you all for your comments. It's good to get some more ideas as we're still at it at night with him. He's only two years old so teething, terrible two's etc is part of everyday life at the mo! :/ We are in regular contact with our DSN but he#s instrycting us to decrease Levemir dose half a unit at a time and then leaving it 3 days to see the effect. It was decreased again the following day, but we're still having the same problem at night so it probably needs to come down again on Monday. I bought some jaffa cakes today so hopefully he'll take those tonight as it's no longer a matter of if we have to wake him up, but when. Also, he has never woken up himself when he goes below 4. We've got him before he's 'too' low though, 3.2 at the lowest, but our DSN told us in the hospital that most people would wake up themselves when having a hypo at night - is it normal to wake up or to sleep?

 

[Bloden]

Hi janaka. Sorry to hear you're up all night with your little one.

As for night-time hypos, personally my body wakes me up (at just under 4 / 3.8) and it's been this way from the start (5 and a half years ago). I don't know if it's the same with kids tho. I'm 46!

Hope you get the levemir dose sorted soon.🙂

 

[Northerner]

From what I've read here and elsewhere, a young child being awoken by a night hypo is not something you can rely on. Also, I think it's a bit dodgy for the nurse to say 'most' people would be awoken - did she say what happens to the people who aren't? When I was newly-diagnosed I would normally wake if I went low in the night, but at quite low levels - in the 2s. It's better for your peace of mind to test in the night, would be my opinion.

 

[Hanmillmum]

Hi. Sorry I haven't been in here since I wrote the message, but thank you all for your comments. It's good to get some more ideas as we're still at it at night with him. He's only two years old so teething, terrible two's etc is part of everyday life at the mo! :/ We are in regular contact with our DSN but he#s instrycting us to decrease Levemir dose half a unit at a time and then leaving it 3 days to see the effect. It was decreased again the following day, but we're still having the same problem at night so it probably needs to come down again on Monday. I bought some jaffa cakes today so hopefully he'll take those tonight as it's no longer a matter of if we have to wake him up, but when. Also, he has never woken up himself when he goes below 4. We've got him before he's 'too' low though, 3.2 at the lowest, but our DSN told us in the hospital that most people would wake up themselves when having a hypo at night - is it normal to wake up or to sleep?

I don't think you can rely on a child to wake, my daughter never has but she has gone to bed and still been awake and felt "funny" and when tested she has been hypo. She is usually clammy if hypo in her sleep, the back of her hair/neck is usually a bit sweaty/damp but she has not stirred, whether that will change as she matures we don't know. She is unsettled if her numbers are ever high and usually wakes then but unfortunately not low. Definitely safe to be checking this early on with him.

Hopefully you'll get the levemir right soon and his numbers can be more stable - fingers crossed 🙂

 

[Redkite]

Hi Janaka and welcome to the forum 🙂

I didn't see your original post until today - sorry to hear about your little boy's diagnosis. My own son was diagnosed aged 4 so I know what you must be going through.

Recommended hypo treatments for a little one at night - full sugar ribena (half a carton sucked through a straw) was the best for my son at that age. Drinks are much easier to get into them when they are sleepy and don't want to chew anything. It sounds like his levemir dose is way too high if he is having so many night hypos. Usually the clinic team will be quite cautious with a newly diagnosed child, starting off with very small doses and only increasing them very gradually. What can happen is that a newly diagnosed child, once started on insulin, can have a "honeymoon period" where their pancreas sputters into life for a little while and gives out a little insulin. Not every child has a honeymoon period, but when it happens, a child may need much less insulin for a while. I would suggest asking your DSN if your son could be having a honeymoon period and need a larger reduction in his levemir.

On the subject of hypos during sleep, your DSN is incorrect to say that everyone wakes up when they are hypo. In fact, the use of CGMS (continuous glucose sensors) has conclusively shown that the majority of children DO NOT wake up when low. I know for a fact that my son never wakes when he is hypo, as I have found him asleep and hypo many times. There is no sugar-coating this - when a child remains at a very low BG level for several hours, there is a small but very real risk of death occurring. The vast majority of children with nocturnal hypos will wake in the morning feeling dreadful, but a tiny number each year never wake up (known as dead-in-bed syndrome). Others may suffer seizures in their sleep, which could lead to brain damage. For this reason, many parents (myself included) set an alarm each night to test BG level at about 2-3am.

I know this is bleak information to receive, but it's better to know the facts and not be one of the (albeit rare) tragic statistics.

On a more positive note, we've integrated diabetes into our lives and it hasn't prevented my son from doing anything he wants to do, though some things might need a bit more planning. 🙂. I highly recommend you get a copy of the book "Type 1 Diabetes in Children, Adolescents and Young People" by Ragnar Hanas, which is a fantastic book, really upbeat and optimistic and full of useful information and advice about managing type 1.

http://www.amazon.co.uk/Type-1-Diab...8&qid=1390687257&sr=8-1&keywords=ragnar+hanas

 

[KateR]

Welcome to the forum Janaka.

 

[Janaka81]

Thanks again for great tips for nighttime hypos - we had in our heads that we should try to push for low GI carbs... I am confident that we have some more 'workable' solutions to try now so thank you!! 🙂

We would always check him every 2-3 hours during the night anyway (or more often depending on his readings) at the moment as we're not 100% clear on the insulin effects and especially since we know that once the Levemir kicks in (seems to be after four hours?) his blood sugar level drops fairly substantially at the moment. But it did make me think whether we would ever get to a stage where we would be 'able' to not check him.

 

[Bloden]

Thanks again for great tips for nighttime hypos - we had in our heads that we should try to push for low GI carbs... I am confident that we have some more 'workable' solutions to try now so thank you!! 🙂

We would always check him every 2-3 hours during the night anyway (or more often depending on his readings) at the moment as we're not 100% clear on the insulin effects and especially since we know that once the Levemir kicks in (seems to be after four hours?) his blood sugar level drops fairly substantially at the moment. But it did make me think whether we would ever get to a stage where we would be 'able' to not check him.

I've read that we should aim for an overall medium gi at each meal, otherwise when the rapid gets to work, the food hasn't been digested yet.🙂
What does ev1 else do?

 

[Northerner]

I've read that we should aim for an overall medium gi at each meal, otherwise when the rapid gets to work, the food hasn't been digested yet.🙂
What does ev1 else do?

I eat generally medium GI, although I don't rule out higher GI - I just adjust the timing of my injection (inject earlier for high GI so the insulin is peaking earlier after eating). Not something that you could do with a child though, as their eating could be unpredictable, but I am able to stick to my schedule closely.

 

[Redkite]

I've read that we should aim for an overall medium gi at each meal, otherwise when the rapid gets to work, the food hasn't been digested yet.🙂
What does ev1 else do?

Everyone needs to find the diet that suits them personally! 😉

Because my son is on a pump, he can eat more or less anything he chooses and we can deal with it using a combination of extended boluses and adjusted basal rates. But when he was on MDI we had to use different approaches. For low GI foods like pasta he would have to have two injections, part with the meal and part a couple of hours later - otherwise he would go hypo soon after eating and be high later due to the longer digestion time of the food.

However, if he were to have pasta for tea after swimming or cycling or a long hike (for example), he would not need the second half of his meal insulin, because the long duration of the pasta digesting balanced out the drop in BGs that he would otherwise have had due to the after effects of the exercise and the action of his long-acting insulin. (IYSMIM!!).

So to make our lives easier, I tended to give him simpler carbs for tea (high-medium GI), e.g. potatoes or bread for the carb element, so that it wouldn't impact on the nighttime, UNLESS he'd been doing lots of energetic exercise, in which case a low GI meal was useful.

 

[annie739]

Our son was diagnosed 5 weeks ago and was having hypos every night .It is so tough to have to try and keep him awake long enough to eat the snack! I think he is having a very distinct 'honeymoon' period as he has now had no levemir for a week, no hypos at night and only one reading in double figures. I think this is quite unusual and the hospital were quite nervous about it but it is working so far for us. He is 9 so a different ball game to a toddler.Luckily things have been good so far for us with school being brilliant ( helped by the fact that they already have 2 T1 children there) It is such a steep learning curve isn't it?