High sugar spike and headache in 10 year old

[Vegpot]

Hi all
My son was diagnosed Type 1 last October and will be 11 in July. He has had a phase lately of running high for no obvious reason although we both had a nasty throat bug about a month ago which played havoc with his levels. They have just started coming back down into the kind of zone he was running in before but the question I have is that today with his dad (we are separated) he apparently shot up to 22mmol early afternoon but ketones 0 but he hadn't had a massive meal apparently and hadn't had any obvious problem with the novorapid. He ended up crying with an awful headache so his dad took him out for a walk to get some air and work off some sugar, after a dose of Calpol. Has anyone had this kind of thing with the nasty headache and is it something I need to be checking with the nurse?
I get so worried so much of the time as it is, and then these horrible glitches make it worse, especially as we are going on holiday in 2 days!

 

[Northerner]

Hi Vegpot, welcome to the forum 🙂 I'm sorry to hear that your son has experienced this problem. Sometimes stress or excitement can raise levels unexpectedly, so might this have been a factor? What had they been doing? People experience different symptoms when high - personally, it makes me feel nauseous, but I know a lot of people also experience headaches. Just a note about exercise when high though - as a Type 1 on insulin it's not recommended that you exercise when levels are above 17 mmol/l as there is a danger that they could go higher. High levels are generally a sign of an insufficiency of circulating insulin to cope with the glucose in the blood (whether derived from food or due to a 'liver boost' from stress/excitement), so the usual solution is to give an extra 'correction' dose of insulin and wait for levels to return closer to normal before exercising.

If you are not familiar with corrections, then do speak to your DSN about it as you need to determine what amount of insulin to give in order to bring the levels down, but not too far (for example, for me 1 unit of novorapid lowers my levels by 3 mmol/l).

Try not to worry (easily said, I know), these things do happen to all of us from time to time. The key thing is to try and look for a reason, especially if it happens more than once. Is there a possibility that the test was wrong because his fingers weren't clean?

I hope that this was a one-off and that you have a lovely holiday 🙂

 

[everydayupsanddowns]

Hi Vegpot

Sorry to hear your son has been having a rough time

I've not had a headache with highs, though they are well know to dehydrate so I guess that could be a factor. Rapidly moving BGs though (in either direction) usually make you feel pretty grim.

Difficult to know what could have caused the highs from what you've said - perhaps some of the other parents will have better ideas/insight. I know that growth hormones etc can wreak havoc on the BGs of young people so perhaps he is just gearing up for a bit of a growth spurt?

Good news that he didn't have ketones, which suggests more of a 'blip' than a longer term problem. As Alan suggests is might be worth discussing the situation with your DSN to try to get some 'ground rules' in place if the same thing happens again.

 

[Vegpot]

Thank you for the welcome and supportive and understanding replies. I know it's not advisable to do exercise when high but he needed some air and they were walking rather than doing a lot of high exertion, actually when they got back his headache was better and his level was 11!! Not much later I went to pick him up to drive him back home and checked beforehand several times if he was hungry at all as it was getting late afternoon by then, he was adamant he wasn't as he'd also had a stomach ache much of the afternoon. Part way through the 40 minute drive home he suddenly announced he was hungry - then 5 minutes later he was *really* hungry, uh-oh. I couldn't stop safely at that point and said we would test him as soon as we got home as I didn't want to risk giving him a snack having been so high before. It's so difficult to know what to do for the best at times isn't it. Lo and behold we got home, tested him and he was 3.4!! What a yo-yo day, I've never known one like it - I wonder if he had a shortlived bug or something that made him off colour? He had a carton of juicy water and 15 minutes later was 4.6 so I made his tea at very high speed with his Novo afterwards and it will be interesting to see his level at 9pm. He has had a funny day with mealtimes a bit delayed today which hasn't helped so I hope later he will be more settled but should I test him in the night after this?

 

[Vegpot]

We have only had to do a very few correction doses up to now and we always did them at mealtimes, using the ratio that adding 1 unit of Novo reduces his blood sugar by about 4 according to our nurse. I will check with them about when to give correction doses in the future in case this happens again. We are still very much in the early phase of learning and understanding how to manage this condition so I am sure we won't be getting things right some of the time, but his last 2 hba1c tests were both good so hopefully we are on the right track - wish the same could be said for my stress levels which are permanently running too high!

 

[Northerner]

Vegpot, do you know what he had to eat for lunch that day and when his novorapid was injected? It sounds possible that his meal peaked, sending him high, then the insulin started kicking in afterwards which sent him low. Timing of insulin can be important with certain types of food so that the insulin is peaking when the food is also peaking in digestion. Unfortunately, it is only through experience that you learn what the best approach is, but I am sure you will get there - you are doing a great job so far and it's good to hear that his HbA1c's are good 🙂

p.s. in the circumstances you probably did all the right things, as a correction might have sent him very low! He clearly had lots of insulin circulating to bring him down to 11 after his walk so exercising at a high level in such circumstances is less of a problem.

 

[Vegpot]

Hi Northerner
From the food diary it says 12.4 at breakfast, which is high for him, 127g carb breakfast so big meal with 8.5 units of novo on a 1:15 (all meals) ratio. By 1.30pm he was 22.9, had cheese on toast to the value of 32g carb and a corrected dose of 5 units of novo but then afterwards was crying with a bad head and stomach pains but he didn't feel sick or have an obvious upset tummy going on. Then they went for a walk, he felt better although not fully well and then later in the afternoon I picked him up and the details are above. Could a correction dose cause headache and stomach ache?

 

[Northerner]

Hi Northerner
From the food diary it says 12.4 at breakfast, which is high for him, 127g carb breakfast so big meal with 8.5 units of novo on a 1:15 (all meals) ratio. By 1.30pm he was 22.9, had cheese on toast to the value of 32g carb and a corrected dose of 5 units of novo but then afterwards was crying with a bad head and stomach pains but he didn't feel sick or have an obvious upset tummy going on. Then they went for a walk, he felt better although not fully well and then later in the afternoon I picked him up and the details are above. Could a correction dose cause headache and stomach ache?

Wow, that is a lot of carbs for one meal! I can only usually manage a slice of toast for my breakfast, but I guess he is a growing lad 🙂 One thing I would say is that a carb-heavy meal may require a different strategy with regard to the insulin - I don't know from personal experience, but I have read others say that they need to sometimes change their ratios when eating a such a meal i.e. give more insulin above a certain number of carbs. This might explain why he was high at 1:30. The cheese on toast may have continued to keep levels high(which may have caused the stomach ache and headache) before the insulin began to kick in during and after the walk.

Talk it over with the DSN and try to get possible explanations clear in your mind. In this way you will learn a great deal from the experience and it is surprising how quickly things begin to become clearer and your estimations and actions become more accurate (whenever The Diabetes Fairy isn't around to play with your mind! 😱 😉)

 

[Vegpot]

Hi
Yes sometimes he does have huge meals, in terms of carbs and fat occasionally and he isn't overweight although he has put weight on since his insulin regime started, partly due to regular snacks and partly due to having lost some weight being ill I guess. He is a growing lad as you say and doesn't eat to this scale all the time, but I take your point about the content of a meal. However, he has eaten meals of this kind before and not had a spike like today, it could be hormones as well I suppose as he is getting to that age of greasy hair starting and a few spots -aaagh!!

 

[Northerner]

Hi
Yes sometimes he does have huge meals, in terms of carbs and fat occasionally and he isn't overweight although he has put weight on since his insulin regime started, partly due to regular snacks and partly due to having lost some weight being ill I guess. He is a growing lad as you say and doesn't eat to this scale all the time, but I take your point about the content of a meal. However, he has eaten meals of this kind before and not had a spike like today, it could be hormones as well I suppose as he is getting to that age of greasy hair starting and a few spots -aaagh!!

There are many extra factors to consider, unfortunately, at his age. I was fortunate to be diagnosed aged 49 so I'd done all my growing! I hope that it was just a glitch and that it doesn't happen again any time soon 🙂

 

[everydayupsanddowns]

Hi
Yes sometimes he does have huge meals, in terms of carbs and fat occasionally and he isn't overweight although he has put weight on since his insulin regime started, partly due to regular snacks and partly due to having lost some weight being ill I guess. He is a growing lad as you say and doesn't eat to this scale all the time, but I take your point about the content of a meal. However, he has eaten meals of this kind before and not had a spike like today, it could be hormones as well I suppose as he is getting to that age of greasy hair starting and a few spots -aaagh!!

Hi again Vegpot

Sounds like ou are doing very well adapting to your sons diagnosis. Diabetes can be annoyingly quirky. There are so many subtle interactions at play which can all differ slightly from person to person that while certain general principles tend to hold true, the real nitty gritty detail will be absolutely individual to your son.

I'm having a slightly turbulent few days myself, but I know for sure that is down to the school holidays where it has now been over a week since I went to the gym. It seems to take over a week of slightly insulin requirements before it settles - by which time the holidays will have ended 🙄

Here are a few things you could add into your considerations (assuming your son in on 4x (or 5x) injections a day):

Meal doses and corrections rarely work reliably and consistently until you have spent some time testing and adjusting your background (basal) insulin dose(s). You can test and adjust this systematically. Ideally basal should keep levels steady when no meal carbs are eaten (ie you can miss a meal and BGs will barely move). Waking levels should be within 1.7 of bedtime with little movement in between (this is not always 100% possible on injected basal insulin, but finding the best possible is still very useful. Once you have got the basal insulin set 'right' for now you will then need to consider/monitor it as it is likely to change over the course of a year.

It should not be necessary to snack regularly to stave off hypos. If your son is snacking to 'feed' his insulin it suggests that either the meal doses or the background/basal need tweaking.

Even modern 'rapid' insulins are not very rapid. It can take a good hour for them to be fully up to speed. Given that it often takes 30 minutes or so to eat a meal this can mean that injecting after meals gives the food (which on many cases is faster than insulin anyway) an hour and a half head start. It can help levels after meals to take the meal dose either 20 minutes before or immediately before eating. Something you would need to experiment with to find out.

Large/carby/fatty meals will be absorbed more slowly. Oddly this can mean (if you give the full dose up front) that levels dip into hypo soon after the meal but then continue to rise for many hours after the hypo has been treated as the carb load gradually arrives. For these meals some find it helpful to take part of the dose before the meal and the rest an hour or two after finishing. Effectively 'spreading' the action of the insulin over more hours.

Best of luck with your ongoing experiments. Hope your sons levels play a little fairer in the coming days 🙂

 

[MeanMom]

Hi Vegpot

Agree with everything above but just wanted to add one thing-

If my daughter was that high when she woke up I would just double check that something 'weird' hadn't happened with her basal the night before (correct amount? injecting into same spot every night?) and/or if it was possible she had been hypo in the night and it wad a 'rebound'.

Also did he get up quite early, lie in or get up then not eat for a while? All these will effect. We find if we do anything out of normal 'routine' levels start being unpredictable. It's difficult to keep any child to a rigid routine so sometimes we just accept defeat and that tomorrow is another day.

(that is a big breakfast - do you know what it was? Although my daughter does get a headache from being high my first thought with headache/stomache ache would be that she'd eaten too much carby/fatty foods - I'm not 'finger pointing - they all do it sometimes - but as our DSN said to us early on 'it's not always the Diabetes')

Hope this was just a 'blip' and you get back on track - if you've had good HbA1c's sounds like you're getting it right really, wel done 🙂

 

[Rosie.H.]

Hi just a thought, but when my son has very high spikes late morning that don't easily come down, and when they do they come crashing down, it is usually because he has had a hypo in the night, usually around the 2am mark. i might be wrong but i thinks is to with the glucagon produced by the body to bring his sugar levels up, it lasts a long time and pushes bg up. Rosie